What is Mohs Surgery?
Mohs surgery is a specialized technique for removing skin cancer. It consists of three essential steps: cutting out the skin cancer, producing microscope slides of the removed tissue while you remain in the office, and evaluating the slides under a microscope to determine whether the cancer has been fully removed. It is an exacting, time-consuming procedure that requires the in-office services of both a physician who cuts out the cancer and interprets its microscope slides and a technician who specially processes the excised tissue and makes microscope slides of it.
The tissue slides are made in a specialized fashion that allows for an examination under the microscope of the entire peripheral and deep margins of what has been cut out. Dr. Miller evaluates the slides using a microscope to determine whether any cancer remains at the edges of what has been excised. Any remaining cancer is mapped out and only the cancer-involved tissue is then further removed, and new microscope slides are made of this tissue and examined. The process is repeated until the edges of the excision appear free of cancer.
When the cancer is cleared, a decision is made about how to best repair the surgical defect. In most instances, the surgical repair of the defect produced by Mohs surgery is done in the office on the same day. Dr. Miller will discuss repair and healing options with you.
What are the advantages of Mohs surgery?
There is a very high cure rate and a low chance of the tumor reappearing after Mohs surgery is performed. Since only tissue containing cancer is removed, the size and shape of the surgical defect corresponds to the extent of the cancer, and the amount of excised tissue is minimized. Simply, put, the advantage of Mohs surgery is: you get a maximum chance of cure for the smallest possible surgical hole. If the hole turns out to be big, it’s because the cancer was that big!
Is Mohs surgery best for all skin cancers?
Absolutely not. The procedure is recommended selectively for the treatment of more aggressive skin cancers, some recurrent (regrown) and previously treated skin cancers, and skin cancers located in cosmetically and/or functionally crucial areas such as the nose, ear, eyelids or lips. Dr. Miller will discuss treatment options and the rationale for his recommendations with you.
How will my surgical defect be repaired?
There may be various options, some relatively simple, and others more complicated and time-consuming, for the repair of the surgical defect (hole) produced by the cutting out of a skin cancer. In most cases, a surgical repair of the defect is done on the same day as the Mohs surgery. This requires additional surgery and the placement of multiple sutures that will have to be subsequently removed in the office. The time frame for suture removal varies from 5 to 14 days after the surgery. Be prepared to be available for returns to the office during this time period following your surgery. In rarer instances the surgical repair will necessitate several follow-up office visits and possibly secondary procedures during the course of several weeks. Dr. Miller will discuss likely return office visit needs prior to your surgical repair.
Day of Mohs Surgery and Preoperative Instructions
- It is best to eat a normal meal the day of your surgery.
- Take all of your normal medications unless directed to do otherwise by Dr. Miller or another of your treating physicians.
- Wash the surgical area with soap and water the morning of surgery.
- Do not apply any cosmetics to surgical site and surrounding areas the day of surgery.
- Avoid drinking alcoholic beverages and taking ginkgo biloba the day before and the day of surgery, as they can promote bleeding.
- Mohs surgery is time-consuming. Be prepared to possibly spend the entire day in the office. Although there are plenty of new magazines to read in the waiting room, and the waiting room company may be entertaining, you may consider bringing your own reading material for your enjoyment.
- Mohs surgery is done in the office under local or local nerve block anesthesia. You will be awake. You may be able to drive home, but keep in mind that a bandage may interfere with your field of vision, and the emotional fatigue of spending time in the office may interfere with your optimal driving performance. For these reasons, it is wise to have a driver available as back-up.
After Mohs Surgery
- You will have a bandage on your surgical site.
- You will usually be asked to keep the bandage intact, undisturbed and dry for 2-3 days following your surgery.
- You may be asked to return to the office for bandage removal on the second or third day after surgery.
- You should avoid consuming alcoholic beverages or ginkgo biloba for at least two days after surgery, as they can promote bleeding.
- Heavy exercise and other activities that generate a rise in blood pressure should be avoided for at least 2 days after surgery, as they may stimulate bleeding.
- Activity limitations will vary depending upon the location of the surgical site and the type of repair done. You may be asked to avoid action sports that could result in trauma to the healing site until the sutures are removed, or longer.
- You will need to return to the office usually after 5 to 10 days, and sometimes later, for suture removal.
- Occasionally, specialized surgical repairs will require multiple postoperative office visits and subsequent additional planned surgery in order to optimize the cosmetic outcome. Such situations would be discussed with you.