What Is Mohs Surgery?
Originally developed in the 1930s, Mohs micrographic surgery has been refined into the most advanced, precise, and effective treatment for an increasing variety of skin cancer types. Mohs Micrographic Surgery is a safe and effective treatment for skin cancer that thoroughly excises the tumor while only mildly disturbing surrounding tissue. It is accepted as the single most effective technique for removing Basal Cell Carcinoma and Squamous Cell Carcinoma (BCCs and SCCs), the two most common skin cancers.
The Mohs procedure involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached. Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%.
Advantages Of Mohs 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.
Which Cancers Need Mohs Surgery?
Mohs surgery offers the highest cure rate among treatments for skin cancer and can be used for practically any type of skin cancer. There are many other acceptable skin cancer treatment options including freezing (cryosurgery), scraping & burning, surgical removal. (excision), and laser surgery, which all require the surgeon to estimate how extensively to treat the area around the tumor. There are many advantages to Mohs surgery compared to other other skin cancer treatments including its high cure rate and cost-effectiveness. It is especially appropriate for skin cancers that:
Develop on areas where preserving cosmetic appearance and function are important
Have recurred after previous treatment or are likely to recur
Are located in scar tissue
Are large
Have edges that are ill-defined
Grow rapidly
The Mohs Procedure
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:
A surgery starts with surgeon examining the visible lesion and planning what tissue to remove. The patient then receives local anesthesia.
The surgeon removes the visible portion of the tumor using careful surgical techniques.
The surgeon removes a layer of skin and divides it into sections. A map is drawn to track where each portion of tissue originated.
The surgeon uses a microscope to examine each section of tissue in search of remaining cancer.
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.
The process stops when there is no longer evidence of cancer. The surgeon discusses reconstruction options and post-operative care.
Mohs Surgery Post-Operative Care
After Mohs surgery, patients may experience mild discomfort, bruising and swelling around the treated area. Prescription pain medication is available for patients if needed, although most only require Tylenol for pain relief.
There will be scarring after Mohs surgery once the area is healed, although the scars from this procedure are often smaller than those from other excision procedures. For patients concerned with the appearance of their skin after treatment, reconstructive procedures are available to reduce or even eliminate the appearance of the scar using skin flaps, skin grafts, collagen injections and more.
FAQs
Why is it called Mohs Surgery? Is Mohs an acronym?
The term “Mohs” refers to Dr. Frederic Mohs, Professor of Surgery at the University of Wisconsin, who developed this surgical technique in the 1930s. The technique has undergone many refinements and has come to be known as “Mohs micrographic surgery” or simply “Mohs surgery” in honor of Dr. Mohs.
What is Mohs Surgery?
Dr. Mohs recognized that a skin cancer often resembles the “tip of the iceberg” with more tumor cells growing downward and outward into the skin like the roots of a tree. These “roots” are not visible with the naked eye, but can be seen under a microscope.
Mohs surgery is a highly specialized and precise treatment for skin cancer in which the cancer is removed in stages, one tissue layer at a time. It is an outpatient procedure, performed under local anesthesia, and is distinguished by a specific technique of tissue examination that is unique to Mohs surgery. Although other surgical specialists may check excision margins, this form of pathologic examination of the tissue is not the same as Mohs surgery.
How long does Mohs Surgery take?
Mohs surgery is performed on an outpatient basis in your doctor’s office. 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.
Most Mohs procedures can be performed in three or less stages, which usually takes less than four hours to perform. Some cases may take longer, as there is no way of predicting the extent of cancer growth before treatment begins. Patients should arrange for someone to take them home following surgery.
Will Mohs Surgery leave a scar?
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.
For patients concerned with the appearance of their skin after treatment, reconstructive procedures are available to reduce or even eliminate the appearance of the scar using skin flaps, skin grafts, collagen injections and more. These procedures may be performed at the same time as Mohs surgery or at a later date.
Is Mohs Surgery the most cost-effective treatment option?
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.
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