Process of Mohs Surgery

July 13, 2020 9:15 am Published by

Mohs surgeons do the Mohs surgeries; these surgeons are dermatologists by profession. While they do the surgery, most patients are alert and awake. Therefore, this treatment can be done easily and safely in a surgical suite or a medical office. However, if they schedule an extensive surgery, you’d be admitted to a hospital.

Should I Go for Mohs Surgery?

Mohs surgery is the benchmark for the treatment of several basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), even those in beauty and structurally growing reputation from around eyes, nose, lips, ears, scalp, fingers, toes or genitals. Due to its success rate, many experts recommend it for SCCs or BCCs, which are aggressive, large or rapidly growing with indistinct edges, or have recurred after previous treatment. Also, some successful surgeries are being done on melanoma cases.

Below are a few examples why Mohs surgery has received such great response:

  • The highest cure rate
  • Up to 99% success rate of an untreated skin cancer
  • Up to 99% success rate of a recurred skin cancer

Process of Mohs surgery

This treatment is done in a single visit but in different stages with required time gaps between each stage. Once the tissue layer is removed, the surgeon examines it in an on-site lab with the help of a microscope. If they find any cancer cells, they remove another tissue layer from that specific spot. It has to be done carefully to prevent any healthy tissues from being removed.

This process is repeated until all cancer cells are removed.

Step 1: Preparation

During the surgery, you can either wear your street clothes or the hospital gown – it entirely depends on what area we are treating. The Mohs surgeon will study the area where the biopsy was done and will most likely mark the area for reference. Your position will depend on what angle the doctor finds more feasible to work with – you lying down or sitting up.

The surgical drape is placed over the area, and if an area on your face has to be treated, you, most likely, won’t be able to see the treatment, but your doctor will keep telling you what’s happening. Right before the procedure starts, the surgeons will inject local anesthesia, which completely numbs the area so you won’t feel any pain.

Step 2: Top layer removal

The surgeon will remove the cancerous tissue layer using a scalpel. Certain skin cancers cells have long extensions or roots, which a naked eye can’t see. To identify such cells, your surgeon will make sure to conduct a lab analysis of the cells. During lab analysis, the surgeon will cover the wound with a bandage.

Step 3: Lab analysis

Doctors then cut tissues into pieces, code them with colors sing dyes, and then draw the surgical site’s map. The technician in the lab freezes the tissues and then cuts thin horizontal slices of it. The slices are placed on microscope slides, stained and covered. The surgeons ensure to carry out all these processes very carefully, and so, it is time-consuming.

Step 4: Microscopic examination

The surgeon then examines the undersides and edges of the tissue on the slides, using a microscope. If s/he finds any remaining cancer cells, it is marked on the map the area the doctor is treating. After this procedure, the physician then decides whether further tissue layer removal is required.

Step 5: Second layer removal

If another layer of skin has to be removed, the doctors will inject more anesthesia. Then, the skin, which has cancer cells remaining, will be removed. The lab work resumes once they do this. This whole process is repeated until all the cancer cells are removed from the skin.

Step 6: Wound repair

Once the cells are removed, the surgeon, depending on the location and size, may decide to let the wound stay open or close with stitches. In certain situations, the wound may have to be reconstructed with a skin flap. For this, skin tissues from close by areas are used, or skin grafting is done. At times, Mohs surgeon may even approach plastic surgeons, hand surgeons, or oculoplastic surgeon for your wound to be repaired. However, in most cases, the wound is immediately repaired by a Mohs surgeon after getting clear margins.

Step 7: Almost Done

If the procedure requires more than two series, it can take several hours to complete it. So, be prepared for that. However, the good part is that it’s worth the time – this precise method has the highest success rate without any extra or unwanted damage to healthy tissues. To obtain the required results, make sure you follow the doctor’s recommendation for wound and scar care and keep a follow-up.

After the Surgery

Once the cancer-filled- tissues are removed, your surgeon will discuss the possible options for wound-healing. Depending on the condition, s/he will opt for one of the following:

  • Close the wound with stitches.
  • Let the cut self-heal.
  • Cover the wound by taking a flap of skin from a close-by part of the body.
  • Cover the wound by skin grafting.
  • Close the wound temporarily and schedule a reconstructive surgery later.

After the whole procedure, you will most likely go back home with all the cancer cells removed from your skin. However, a follow-up or staying in touch with your doctor will still be important to ensure the wound is recovering at the required pace.

Post-procedure, you may face problems like redness, swelling, bleeding, or discomfort, but these issues will disappear soon after. Your physician may give instructions and prescribe medications for cleaning to wound.

It’s better to have someone else take you home once the procedure is done. In case you’ve taken sedatives or painkillers, going home alone is extremely unsafe.

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