FAQs about Mohs
Frequently asked questions
What is MOHS Micrographic Surgery?
CMohs micrographic surgery is a highly specialized technique for the optimal removal of certain types of skin cancer. This surgical method often allows for a 99% cure rate of the cancer. Less than 800 surgeons in the world are trained in this technique where one physician acts as the oncologic surgeon, pathologist, and reconstructive plastic surgeon. The skin cancer is removed one layer at a time and analyzed microscopically while you are in the office. Once the skin layer is removed, it is stained and carefully diagrammed. It is then processed immediately in the office by a specially trained technician who converts the tissue into micrographic slides. These slides are then reviewed by the physician to determine if all of the malignant cells have been removed. If there is residual tumor, the Mohs surgeon can determine precisely where it is located since the tissue was previously diagrammed. The exact area where the tissue persists is then removed by taking another layer of tissue, and the process is repeated. The surgery itself takes only several minutes; however, the tissue processing takes anywhere from twenty minutes to one hour, and then upon examination of the slides, a decision is made as to whether or not further surgery is indicated. Each procedure where tissue is removed is referred to as a stage. The term Mohs refers to Dr. Frederick Mohs, who initiated its use in the early 1960′s.
What are the advantages of MOHS surgery?
The Mohs micrographic technique offers the highest possible cure rate (up to 99% for many primary skin tumors) for the treatment of skin cancer, compared to other therapeutic modalities. Mohs surgery also allows the physician to remove as little normal tissue as possible around the tumor, and thus in many cases can provide a superior cosmetic result. Another advantage is that Mohs surgery can be performed under local anesthesia in an out-patient setting. Therefore, even with large skin cancers, hospitalization can usually be avoided.
How many stages of surgery will I undergo?
Each stage consists of the surgical removal of any visible or microscopic tumor, tissue processing, and the slide examination. The average patient undergoes two stages or procedures although 40% of all patients only require one stage.
How long should I plan on spending in the doctor's office?
The length of time depends largely on the size of your skin cancer and the number of stages that are required. You can expect to stay at least two to four hours, however, some patients may be required to stay longer. Remember that the major goal of the procedure is to achieve 100% removal of all of the tumor cells. The removal of the skin cancer will be completed during your office visit.
What happens after the surgery is completed?
There will be a wound following the completion of the Mohs micrographic surgery. There are several options to allow for healing. These options include allowing the wound to heal by itself, suturing through primary closure, skin grafting, and skin flaps. We sometimes choose to use lasers to help the healing process at the time of the procedure and also during the healing phase. In almost all cases we perform the repair of the wound on site immediately following Mohs surgery. It is, however, always your option to select another surgeon for the reconstruction of the postoperative wound.
Will there be any office visits after the surgery?
It will be necessary to see you routinely after the surgery for several months. The frequency of these return visits will depend upon the size and location of your skin cancer. We may use lasers, dermabrasion, and other techniques to allow the scar to heal optimally. After the short-term follow-up visits are completed, the long-term follow-up will be performed by your referring physician.
What are the chances that my skin cancer will return after the MOHS surgery?
Mohs surgery offers the highest cure rate of any treatment method. If your skin cancer has never been treated before, then the chance of recurrence is less than 1%. If your lesion has been treated before, then there is less than a 4% chance or less of recurrence.
What are the alternatives to MOHS surgery?
Mohs surgery is the treatment of choice for recurrent skin cancers, skin cancers that arise in skin that had previous x-ray treatment, and skin cancers near vital organs such as the eyes, mouth, nose and ears. For uncomplicated skin cancers, alternative treatments include routine surgical excision, x-ray treatments or destruction of the tumor by burning or freezing. The cure rate of these treatments is significantly less than Mohs micrographic surgery.
Are there any pre-operative instructions that I should follow?
Aspirin, aspirin-containing products and anti-inflammatory medications (such as Advil, Nuprin, Motrin and Alleve), as well as vitamin E, should be avoided for at least one week prior to the surgery. If you are taking anti-coagulants or having clotting problems, please let the doctor know. You should otherwise continue to take all of your medicines and you should have a breakfast or lunch prior to the surgery. Heavy alcohol use and smoking should also be avoided for one week prior to your surgery.