Mohs Surgery

The biggest advantage of Mohs surgery is that it helps ensure that we remove the entire tumor. We accomplish this by tracking the tumor-removal process at the microscopic level.

Another key advantage is that we remove only the tissue already invaded by the tumor. By using a microscope to guide us, you lose very little of the surrounding healthy skin. This is important if the cancer is close to an important feature, especially on the face.

Of course, there will be scars from Mohs surgery, just as any dermatologic surgery will leave a scar. But by preserving the maximum amount of healthy skin, we can give you the best possible cosmetic result.

Mohs surgery is performed by a specialty trained team that includes:

• A Mohs surgeon (dermatologist).
• A technician who prepares the tissue to be examined with a microscope.
• Several surgical assistants.

Knowledgeable and skilled office staff round out your care and are available to answer your questions. You will meet the entire team during your consultation and on the day of surgery.

Before we begin the surgery, we give you a local anesthesia to numb the site of the tumor. Then, as much of the visible tumor as possible is taken off by scraping with a special instrument. A thin layer of skin at the tumor site is then removed and examined under a microscope.

If evidence of tumor cells is found at the edges of the sample, the doctor will remove and examine another skin sample. We repeat these steps until we no longer detect cancer under microscope.

Depending on the extent of the tumor, this process may be repeated several times.

How Long Will the Procedure Take?

Although the actual surgery in each sampling takes only 20 minutes, the entire process takes about an hour per sample. But we won’t know ahead of time how many stages you need. Be prepared to spend the entire day with us. It rarely takes more than one day to remove a tumor.

It’s not possible to know ahead of time the extent (size and depth) of your tumor. That makes it hard to discuss the repair of your surgical site before the procedure. However, there are several ways of repairing the skin.

Small or superficial wounds may be left to heal by themselves. Larger wounds may need to be stitched closed.

The largest wounds may require a flap or a graft. Both techniques involve moving healthy skin from elsewhere on your body to repair the surgical wound.

When the tumor has been completely removed, and we know the size and shape of the resulting wound, we can discuss with you the best options for repair. Most patients have their wound repaired on the same day we perform the Mohs procedure.

Mohs surgery is considered very safe and highly effective. But as with any surgery, there are some risks, including:

• Bleeding: Some bleeding during surgery is expected. But it’s uncommon for bleeding to occur after Mohs surgery.
• Infection: Infection rarely occurs. If it does, we control it with oral antibiotics.
• Numbness and nerve damage: Most scars are numb because sensory nerves have been cut. Sometimes nearby skin is also numb. Rarely is a tumor located around nerves that control movement. If so, muscle movement may be impaired as a result of nerve damage caused by removing the tumor.
• Allergic reaction: Allergic reaction can occur from the local anesthesia or the bandage.
• Pain and discomfort: Usually, there isn’t much pain or discomfort after Mohs surgery. In fact, most people return to their normal activities the next day. The site may be bandaged for two to six weeks.
• Scarring: Mohs surgery always results in a scar. Scars usually mature over several months, becoming less obvious. Some scars will be pink and bumpy for three to nine months. Often, we can cosmetically alter scars that don’t mature well. If you need surgery to improve the appearance of your scar, it may occur about 12 months after the original surgery.
• Recurrence: Tumors recur in some patients even after we carefully perform Mohs surgery. A recurrence usually looks like a small bump or red scaly area on or close to the surgical site. Recurrences are not usually seen for one to three years. We almost always treat the recurrence with Mohs surgery again because of the technique’s high cure rate.