The Process of Mohs Surgery: A Step-by-Step Guide

Mohs surgery is a highly effective and precise treatment for skin cancer, particularly for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Performed by a trained Mohs surgeon, this procedure offers the highest cure rate for skin cancer while preserving healthy tissue and minimizing cosmetic impact. While most patients remain awake and alert during the procedure, it can be performed safely in a surgical suite or medical office. In cases of extensive surgery, hospitalization may be required.

Should I Consider Mohs Surgery?

Mohs surgery is the gold standard for treating basal cell carcinoma and squamous cell carcinoma, particularly in delicate or high-risk areas like the eyelids, nose, ears, lips, scalp, fingers, toes, and genitals. It’s especially recommended for:

• Aggressive or large tumors
• Tumors with indistinct edges
• Recurrence after previous treatments
• Melanoma cases in certain circumstances

The high success rate of Mohs surgery has made it a top choice for treating skin cancers, providing the following benefits:

• Up to 99% cure rate for untreated skin cancer
• Up to 99% cure rate for recurrent skin cancer

The Step-by-Step Process of Mohs surgery

Mohs surgery is done in multiple stages, with gaps between each stage to allow for lab analysis. The goal is to remove the skin cancer layer by layer, examining each section under a microscope until all cancer cells are removed while preserving as much healthy tissue as possible.

Step 1: Preparation

Depending on the area being treated, you’ll either wear your street clothes or a hospital gown before the surgery. The Mohs surgeon will mark the area to be treated and determine your optimal position, either lying down or sitting up. The surgical site will be draped, and local anesthesia will be injected to numb the area, ensuring you feel no pain during the procedure.

Step 2: Removal of the First Tissue Layer

The surgeon will use a scalpel to remove the first layer of cancerous tissue. Some skin cancer cells, such as those from BCC or SCC, may have extensions or “roots” that are not visible to the naked eye. To detect these hidden cancer cells, the tissue will be sent to the lab for further analysis.

Step 3: Lab Analysis

In the lab, the tissue is cut into small pieces, stained with dyes, and mapped out to ensure precise tracking of where the tissue was removed. The tissue is then frozen, sliced into thin sections, and placed on microscope slides for examination.

Step 4: Microscopic Examination

The Mohs surgeon will carefully examine the tissue samples under a microscope. If any cancerous cells remain, the surgeon will use the map to identify their precise location and then return to remove more tissue from that specific spot.

Step 5: Removal of Additional Layers (if necessary)

If cancer cells remain, additional layers of skin will be removed. More local anesthesia will be administered as needed. This process of removing tissue and examining it under the microscope is repeated until the surgeon confirms that all cancerous cells are eliminated.

Step 6: Wound Repair

Once all the cancer cells are removed, the Mohs surgeon will decide how to close the wound. Options include:

• Stitching the wound closed
• Allowing the wound to heal on its own
• Using a skin flap from nearby tissue for reconstruction
• Skin grafting if necessary. Sometimes, the Mohs surgeon may consult a plastic surgeon or ocular surgeon for further reconstruction.

Step 7: Finalizing the Procedure

The procedure’s duration depends on how many layers need to be removed. While it may take several hours, this meticulous process ensures the highest cure rate with minimal damage to surrounding healthy tissue. Once completed, your surgeon will provide instructions for aftercare, including how to manage any scars and schedule follow-up visits.

After Mohs Surgery: What to Expect

Once the procedure is complete, the surgeon will discuss options for wound care and healing. Common approaches include:

• Closing the wound with stitches
• Allowing the wound to heal naturally
• Using skin from a nearby area for a skin flap or graft
• Temporary closure with a plan for future reconstructive surgery

Most patients can return home the same day, but someone should accompany you, especially if you received sedatives or painkillers. Post-procedure, some swelling, redness, and discomfort are normal, but these symptoms typically resolve within a few days. Your doctor will prescribe instructions for wound care and, if necessary, medications to manage discomfort.

Conclusion

Mohs surgery offers an unmatched cure rate for skin cancer, particularly basal cell carcinoma, and squamous cell carcinoma. It precisely removes all cancerous tissue while preserving as much healthy tissue as possible. The procedure is highly effective, and although it may take time, the results are worth it regarding both oncologic cure and cosmetic outcomes.

Frequently Asked Questions

1. What is Mohs Surgery?

Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer, particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The technique allows for the complete removal of cancerous tissue while preserving the maximum amount of healthy tissue.

2. Who Performs Mohs Surgery?

The procedure is conducted by a trained Mohs surgeon experienced in dermatologic and micrographic surgery. These specialists have extensive knowledge of identifying cancerous tissue through microscopic examination.

3. Is Mohs Surgery Painful?

Patients typically experience no pain during the procedure due to the use of local anesthesia. Mild discomfort or swelling may occur post-surgery, which can be managed with prescribed medications.

4. What Are the Benefits of Mohs Surgery Compared to Other Skin Cancer Treatments?

Mohs surgery ensures the complete removal of tumor cells with minimal impact on healthy tissue. This meticulous approach minimizes scarring and maximizes the conservation of healthy skin, making it preferable for visible tumor sites.

5. How Long Does Mohs Surgery Take?

The duration of Mohs surgery varies depending on the number of tissue layers that need to be removed. While it may take several hours, this thorough method ensures effective skin cancer treatment and aesthetic outcomes.

Categorized in: MOHS