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Mohs surgery is a specialized treatment for the removal of skin cancer. This method differs from other methods of treating skin cancer by using complete microscopic examination of surgically removed tissue and detailed mapping techniques that allow the surgeon to track and remove all the roots and extensions of the skin cancer.
By using microscopic examination with detailed mapping, the Mohs surgeon is able to pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The results are: 1) the removal of as little normal skin as possible, and 2) the highest possible cure rate for the cancer.
The cure rate with Mohs Micrographic Surgery is greater than 99%. In previously treated cancers in which the tumor is recurrent, Mohs surgery is 95% effective.
Immediately after the cancer is removed, a decision is made for the best method to reconstruct the wound created by the surgery. Most frequently, the wound is closed with stitches in a side-to-side fashion, by a skin graft, or by a skin flap. Occasionally, when the wound is small enough, no stitches are required and the wound is allowed to heal on its own. Most patients will not require further procedures after the repair of the surgical defect. However, some repairs are completed in two stages, with the second stage occurring two to three weeks after the initial surgery.Infrequently, a tumor may turn out to be much larger than anticipated. Under these circumstances, another surgical specialist may become involved. If another surgical specialist completes the reconstruction, it may take place on the same day or on a subsequent day. It is not harmful to delay the reconstruction for several days. In very rare cases, this reconstruction may require hospitalization.
Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Also, complete healing of the surgical site may take up to 12 months. During this time, the surgical site may appear red or may feel swollen or lumpy, particularly in the first few months. We recommend that the site be gently massaged beginning 6 weeks after the procedure.
Although your surgeon will remove as little tissue as possible, there are some general risks associated with surgery. Your doctor will discuss these and any additional problems associated specifically with your situation.
- As tumors are often larger than their surface appearance indicates, the wound after complete removal of the cancer may be larger than anticipated. Our primary goal is to remove the entire tumor.
- We make every effort to obtain an optimal cosmetic appearance after surgery. With any excision surgical procedure, scarring will occur at the site of removal.
- Occasionally, the surgical site may be slow to heal, grafts or flaps may fail, or the repair may reopen after closure. The most common risk factors for these include smoking, diabetes, bleeding, poor physical condition, or other disease states.
- Skin cancer can involve the nerves. With removal of the skin cancer, there may be local numbness or, less common, loss of local muscle movement after the procedure. Occasionally, nearby nerves can be injured during the reconstruction of the defect following surgery. For sensory nerves, sensation will usually return over a time period of up to 24 months. Motor nerves are less likely to have a return of function. For damage to major motor nerves, microsurgical repair may be required to salvage function.
- No procedure can guarantee that the cancer will never come back. With Mohs surgery, however, your cure rate will be maximized. Previously treated tumors and large, longstanding tumors have the greatest chance of recurrence.
- Although infection is rare, it can occur. Make sure that you follow your wound care instructions carefully and care for your surgical site on a daily basis.
A pre-operative visit is sometimes scheduled especially for larger skin cancers or for any patient who would like to be seen prior to surgery. This visit will give you the opportunity to meet your doctor and medical staff. An examination of the cancer will be performed and a medical history will be obtained.
Usually only one or two return visits are needed to remove stitches or examine the healed surgical site. Afterwards, you may return to your referring doctor for routine check-ups.It is essential that you have regular check-ups with your physician. After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your referring physician at least once a year, not only to examine the treated skin cancers but also to check for new skin cancers.
- Shampoo your hair the night before or morning of surgery, as your wound and initial dressing has to remain dry for 24 hours after surgery.
- If the skin cancer involves the eye and nose area, we suggest you have a driver on hand because of vision impairment due to excessive bandaging.
- The average length of time patients spend at the surgery center is four hours; you should plan to spend most of the day at the surgery center.
- Due to the limited space in our waiting room, we ask that you have no more than one person accompany you on the day of surgery.
- We do have refreshments available for your comfort; however, we do recommend that you bring lunch and any medications you may need throughout the day.
- If you smoke, try to cut down or quit prior to your procedure and for at least two weeks afterwards. This will impact how quickly you heal, as well as the appearance of the scar.
- Be well rested and eat a good breakfast, unless directed otherwise.
- Take your usual medications, unless directed otherwise.