Mohs Surgery

The Mohs surgery procedure seems simple: the surgeon removes the cancer, carefully checks to be sure the he or she got it all, then repairs the wound. American College of Mohs Surgery members, however, train in and practice the complex nuances of this process for years so they are prepared to handle any situation they may encounter. The steps followed for the Mohs surgical procedure are:

1. A surgery starts with surgeon examining the visible lesion and planning what tissue to remove. The patient then receives local anesthesia.
2. The surgeon removes the visible portion of the tumor using careful surgical techniques.
3. The surgeon removes a layer of skin and divides it into sections. A map is drawn to track where each portion of tissue originated.
4. The surgeon uses a microscope to examine each section of tissue in search of remaining cancer.
5. If the surgeon finds cancer cells under the microscope, he or she marks their location on the “map” and removes another deeper layer of skin.
6. The process stops when there is no longer evidence of cancer. The surgeon discusses reconstruction options and post-operative care.

Although Mohs surgery can take longer than other techniques to perform, advances in technology, such as automated staining of tissue samples, have made it quicker. While it is impossible to predict exactly what timeframe to expect for each Mohs surgery procedure, the entire procedure usually lasts several hours. Rarely, clearing the tumor and reconstructing the defect can take the better part of a day. A consultation with the Mohs surgeon prior to your procedure will allow for the surgeon to understand the unique qualities of your situation and enable him/her to more clearly estimate the extent of the timeframe for the surgery.

Mohs surgery is unique and so effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. The pathology is reviewed on site by the Mohs surgeon, who is specially trained in the reading of these slides, who can then remove more tissue if the margins are not clear. 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.
• Other skin cancer treatment methods blindly estimate the amount of tissue to treat, which can result in the
unnecessary removal of healthy skin tissue and tumor re-growth if any cancer is missed.

When assessing the cost-effectiveness of Mohs surgery there are several factors to consider. Because of the number of personnel involved as well as the advanced technology required, the initial procedure is often more costly than other treatment methods. However, because of the procedure’s high success rate, most patients require only a single surgery. This surgery usually includes the repair of the wound as well. While other methods might initially be less expensive than Mohs surgery, additional surgeries and pathology readings are required to repair the wound and to treat the cancer if it is not completely removed. Each of these additional surgeries and pathology readings will require separate fees, while a single Mohs surgery procedure includes all of these into one fee.

Yes. As will any treatment for skin cancer, Mohs surgery will leave a scar.

Mohs surgery preserves as much healthy skin as possible and maximizes options for repairing the surgical defect, once the tumor is completely removed. Once the Mohs surgeon has completely removed your skin cancer through Mohs surgery, reconstruction for optimizing the final functional and cosmetic result becomes the highest priority. Generally, a post-surgical scar improves with time and can take up to 1 year or more to fully mature. As your surgical site heals, new blood vessels can appear and support the healing changes occurring underneath the skin. This can result in the reddish appearance of the scar. This change is temporary and will
improve with time.

Skin cancer is the uncontrolled growth of abnormal skin cells. It occurs when unrepaired DNA damage to skin cells triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors. This DNA damage is most often caused by ultraviolet radiation from sunshine or tanning beds.

Anyone can get skin cancer, even those who have skin of color. Most people who get skin cancer, however, have lighter skin. People who are more likely to get skin cancer:

• Excessive time spent in the sun
• Use tanning beds or sun lamps
• Resided in an area that gets intense sunlight, such as Florida, the Caribbean, or northern Australia.

Any length of exposure, even if it occurred years ago or was short, increases your risk.

There are also some general characteristics which may increase a person’s risk for getting skin cancer, which include:

• A person’s skin type and the moles on one’s skin
• Family history of skin cancer
• Medical history
• Exposure to chemicals
• Tobacco

To diagnose skin cancer, a dermatologist looks at the skin. A dermatologist will carefully examine growths, moles, and dry patches.

To get a better look, a dermatologist may use a device called a dermatoscope. The device shines light on the skin. It magnifies the skin. This helps the dermatologist to see pigment and structures in the skin.

If a dermatologist finds something that looks like skin cancer, the dermatologist will take a sample of all or part of the suspicious skin. and the sampled skin will be sent to a lab where it can be examined under a microscope. A biopsy should not cause anxiety. The discomfort and risks are minimal.