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MOHS Micrographic Surgery
What is Mohs Surgery?
Mohs Surgery is a complex procedure combining surgical excision of skin cancer with immediate microscopic examination of the entire tissue specimen margin by frozen tissue processing techniques. Named after the procedure’s pioneer, Dr. Frederic E. Mohs, this technique has revolutionized skin cancer surgery. It allows the surgeon to remove a minimal amount of healthy surrounding skin and know the margins are clear before repairing the wound, thereby reducing the resulting scar and the risk of cancer recurrence.
Mohs surgery consists of four steps:
Mohs Surgery Steps
1. The skin is numbed with a local anesthetic. The skin is then marked to create a map. Then, a thin layer of skin containing the tumor is surgically removed. Care is taken to remove only a minimal amount of healthy surrounding skin, known as the tumor margin.
2. The skin specimen is divided into slices that are numbered, mapped, and color-coded in the exact same orientation as the map on the patient's skin.
3. The divided, mapped, color-coded skin slices are processed and placed on glass slides.
4. Each slide is examined under the microscope to determine if extensions of the tumor are left behind in the skin. If the tumor is removed completely, the skin defect is ready to be repaired. If the tumor margin is still positive for cancer, then steps 1 through 4 are repeated until the skin margin is clear of tumor.
This detailed examination of 100% of the margin by Mohs Micrographic Surgery differs from all other pathology techniques. If you have a skin cancer removed by a physician in the office or hospital using traditional technique, the tissue specimen will be sent to a pathology laboratory for processing and examination by a pathologist. Standard pathology techniques can not examine 100% of the tumor borders. So, if the cancer has tentacle-like extensions, it is possible that they will be missed during examination. However, during Mohs Surgery, 100% of the margin is evaluated, making this procedure indispensible for aggressive, infiltrative skin cancers with many tentacle-like projections. Moreover, Mohs Surgery has been proven to have the lowest rate recurrence for the most common skin cancers when compared to any other available treatment option.
The Mohs Surgery technique allows 100% of the surgical margin to be examined and, if tumor is still present, to pinpoint the exact location of the residual cancer and remove it. Since many of the skin cancers removed with Mohs Surgery are complicated, multiple stages are often required to clear the tumor. Please be patient! Examination of each of your stages can take up to 60 minutes. If multiple stages are taken, the Mohs procedure can take up a good percentage of the day.
In summary, the use of Mohs Surgery significantly increases the chance of complete cure and reduces the unnecessary sacrifice of surrounding normal skin. This minimizes the size of the surgical wound, making it easier to repair the defect, and results in a smaller scar.
Advantages of Mohs Micrographic Surgery
* Procedure is performed from start to finish by a skin cancer expert
* Offers the highest cure rate for most skin cancers
* Smallest amount of normal surrounding skin is removed
* All done under local anesthesia in the office.
* 100% of margin is examined – no other technique offers this
* Maximizes post-surgical cosmetic appearance and function of treated area
* Smallest possible defect results in smallest possible scar
* Surgery and microscopic examination by the same person
* Reconstruction performed immediately after tumor removed
How To Prepare for Your Surgery
1. Avoid taking unnecessary aspirin or aspirin-containing products for at least 10 days prior to your surgery. Aspirin thins the blood. Also, do not take other anti-inflammatory pills, headache and cold remedies, or Alka-Seltzer. If your physician recommended that you take the aspirin, please check with him/her before stopping your medication. Please take only Tylenol for a headache or pain. In addition, if you take high doses of Vitamin E, please stop it at least 14 days before the procedure. If you take the blood thinner Coumadin, please check with your prescribing doctor before attempting to stop the medication.
2. If you require antibiotic prophylaxis before dental procedures or other surgery, take your first dose of antibiotics 1 hour before coming to the office for your Mohs surgery. If you do not have a prescription at home, be sure to call us at least 3 days in advance of your surgery date so that we can call a prescription to your pharmacy.
3. If your skin cancer is located in the center of your face, eyelid, or eyebrow area where a bandage will block your vision or impact your ability to wear glasses, please have someone available to drive you to and from the office.
4. Eat a normal breakfast or lunch on the day of surgery. If you wish to bring your own lunch or snacks, we have refrigerator space available for you.
5. Please wear comfortable clothing. Make sure that your shirt buttons in the front and does not slip over your head.
6. Please take a shower and wash your hair on the morning of the day of surgery. Do not apply makeup (if the skin cancer is on your face), perfume, aftershave, or cologne.
7. Take all of your routine medications, as you normally would EXCEPT any of your medications that we have told you to stop (i.e. aspirin or Coumadin).
8. If you are unable to keep the scheduled appointment for surgery, please contact our office at least 48 hours in advance to reschedule your surgery appointment.
Wound Care Instructions After Mohs Micrographic Surgery
Supplies that need to be purchased prior to surgery:
* Petroleum Jelly Ointment or Polysporin antibiotic ointment
* Telfa dressing (non-stick wound dressing)
* Paper tape
All of these items are over-the-counter and are available in drug stores and pharmacies.
Wound Care
The importance of proper wound care cannot be overemphasized. How well you take care of the surgical wound is a critical factor in the success of the procedure.
We ask our patients to follow these steps after most surgical procedures, including Mohs Surgery:
* Keep the post-operative bandage in place for 24 hours. Keep the wound dry for this period of time.
* Limit your activities for the first 24 hours. No strenuous activity or exercise.
* Showering is permitted after 24 hours. Before showering, remove the bandage and discard it in the trash.
* Clean the incision with soapy water (not hydrogen peroxide, alcohol, or any other products) to remove any drainage and crusting. Pat the wound dry and apply a generous layer of Petroleum Jelly or Polysporin ointment to the incision using a Q-Tip (avoid Neosporin, as it can cause skin reactions). Cover wound with a Telfa non-adherent dressing cut into the shape of the wound. Tape the Telfa dressing in place with paper tape.
* Change this dressing at least twice daily until you return for suture removal.
* Wash your hands with soap and water prior to changing the dressing or coming in contact with the wound.
* Avoid applying alcohol, hydrogen peroxide, or any other substance to the wound, other than what is mentioned above.
Pain
Most patients have little to no pain after Mohs Surgery. Should you experience pain, take TYLENOL, not aspirin or ibuprofen.
Prescription Medications
Continue your regular medications as you normally would. Restart your aspirin, aspirin-containing products, Coumadin, and Vitamin E (these were stopped before surgery) on the day after surgery.
Activity Level Following Surgery
Spend the first day after surgery relaxing. Avoid strenuous activity or exercise. Keep your head elevated during the first few evenings with a couple of pillows. Avoid bending below the waist for the first day or two. If surgery was performed around the eyes, apply ice packs during the first 48 hours to minimize swelling. Forehead, cheek, or eyelid repairs may result in a black eye(s) and swelling around the eyes. Heavy lifting and exercise are not allowed until after the sutures are removed. Showering can be started the morning after surgery. Submerging the wound in a bath is allowed if the incision site is not soaked for more than one minute at a time. Pat the wound dry after leaving the shower and reapply the ointment and bandage. Swimming in a pool is not allowed until after the sutures are removed.
