Micrographic Dermatologic Surgery

Mohs Surgery Overview

Micrographic Dermatologic Surgery, commonly referred to as Mohs surgery, is a precise and highly effective outpatient procedure used to treat certain types of skin cancer, especially those found on the face and neck.

Mohs surgery is minimally invasive and is performed in the office under local anesthesia. During the procedure, the Mohs surgeon begins by removing a thin layer of skin containing cancer cells. The surgeon then carefully examines the tissue under a microscope and precisely identifies and maps where the cancer cells are seen. Upon review, if any cancer cells remain at the edges of the tissue, the surgeon will repeat the process until no other cancer cells are found. The layer-by-layer skin removal approach allows surgeons to spare as much healthy skin as possible since they only remove the skin with cancer cells, leaving the normal skin intact.

Once the cancer has been removed, the Mohs surgeon will provide options to repair the wound. Options include natural healing, stitching the wound together, using a skin flap or graft, or referral to a plastic surgeon for complicated repairs.

Advantages of Mohs Surgery

Mohs surgery is unique and effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. Advantages of Mohs surgery include:

  • Ensuring complete cancer removal during surgery, virtually eliminating the chance of the cancer growing back
  • Minimizing the amount of healthy tissue lost
  • Maximizing the functional and cosmetic outcome resulting from surgery
  • Repairing the site of the cancer the same day the cancer is removed, in most cases
  • Curing skin cancer when other methods have failed

Mohs surgery is usually completed the same day, depending on the severity of the tumor and the amount of restoration to the wound.

Success Rate of Mohs Surgery

Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%.

Possible risks

While Mohs surgery is typically a very safe and effective minor surgical method, most medical procedures carry some risks, though they are minimized in the hands of a qualified Mohs surgeon. Risks include:

  • Bleeding
  • Scarring
  • Discoloration
  • Nerve damage
  • Pain
  • Cancer recurrence
  • Need for additional reconstructive surgery

Am I A Candidate for Mohs Surgery?

Whether or not Mohs surgery is right for you depends on multiple factors, including the type of skin cancer and the tumor’s location. Mohs surgery is often used to treat skin cancers on the face, scalp, hands, feet and genitals, though it can be used on other areas of the body.

Though most often used for low-risk cancers, Mohs is also used to treat high-risk or recurring skin cancers because of its ability to altogether remove the tumor with a high degree of accuracy.

Often, if you have basal cell or squamous cell carcinoma and are at risk for recurrence, you are a good candidate. It is also a good choice for patients with tumors larger than two centimeters, tumors that have regrown after previous treatment or tumors in locations like the face, where it is critical to preserve the surrounding tissue.

This procedure is also ideal for removing tumors with poorly defined borders, as well as tumors in patients with suppressed immune systems.

The Mohs Surgery Procedure

Before the procedure, your dermatologist will discuss your medical history and will explain the potential risks and expected outcomes of the procedure. Be prepared to list any prescription and over-the-counter medications and supplements you are currently taking. The surgeon will also provide more information about the procedure and ways to ensure a successful outcome.

Prior to surgery, patients will receive local anesthesia around the area of the tumor, so they will remain awake during the procedure. The local anesthesia will completely numb the area, allowing patients to be as comfortable as possible. Once the site has been numbed, the surgeon will begin removing the visible tumor and the surrounding tissue. Next, the tissue will be placed on a slide for the surgeon to examine under a microscope.

If the surgeon finds cancer around the edges of the tissue removed, they will repeat the process until all samples are free of cancer. While there are exceptions, most tumors require one to three stages until completely removed.


Mohs Surgery Step-By-Step Process

Skin cancers may have roots beyond the visible tumor.
The visible tumor is removed first.
The specimen is divided into sections and mapped to the surgical site.
The tissue is microscopically examined on its undersurface and edges.
Any remaining cancer cells will be removed with precision. This step may be repeated for complete removal of the cancerous tumor.
The surgery is complete when no evidence of remaining cancer can be found. The surgeon will then discuss options for reconstruction of the surgical site.

What to Expect After Surgery

When your surgery is complete, the Mohs surgeon assesses the wound and discusses ideal functional and cosmetic reconstruction options. Good cosmetic results are an integral part of the recovery process, and that’s why the surgery is aimed to leave as little tissue damage as possible. If reconstruction is necessary, the Mohs surgeon usually repairs the area the same day as the tumor removal.

Most patients can drive themselves home following the procedure. Pain associated with the procedure typically is minimal and temporary. Your doctor may advise you to take an over-the-counter pain reliever or a prescription pain-reducing medication if necessary. Limitations on physical activity depend largely on the extent of the surgical procedure. Patients whose wounds were repaired with stitches will typically need to return to the doctor’s office within one to three weeks for their removal.

After a Mohs surgical procedure, you may or may not undergo a repair process to mend the wound left by the surgery. Several reconstruction options exist, and instructions for aftercare are different depending on which approach the surgeon takes.

The surgeon and his or her medical team will provide you with detailed instructions to follow at home. Those instructions will include:

  • Information about when to change bandages and how to clean the surgical site
  • Medication information about prescription or over-the-counter pills or topical ointments
  • A timeline for when you can return to certain activities, such as wearing makeup or exercising
  • A schedule of follow-up appointments to remove any stitches and monitor your healing
  • Recommendations for treating your Mohs surgery scar to ensure it heals and fades quickly

Some patients may experience mild discomfort, bleeding, redness, or inflammation, but these symptoms are typically temporary and easily manageable.

Sources: Mohs Surgery for Skin Cancer. American Society for Dermatologic Surgery. https://www.asds.net/skin-experts/skin-treatments/mohs-surgery


Patient Resources

For more information about Mohs surgery, visit www.aad.org or www.asds.net.

Hattiesburg, MS
Dermatology - South
3 Thompson Park
Hattiesburg, MS 39401
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