Mohs Surgery

WHAT IS MOHS SURGERY?
Moh’s surgery is a specialized, highly effective technique for removing skin cancers. It was developed in the 1930’s by Dr. Frederick Moh’s at the University of Wisconsin and is now practiced throughout the world. Moh’s surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancer tissue so that all roots and extensions of the cancer can be eliminated. Moh’s surgery has the highest reported cure rate of all treatments for skin cancer. Treating all skin cancers with Moh’s surgery is not necessary. Mohs’ surgery is reserved for skin cancers that grow back after previous treatment, cancers that are at high risk of recurring, or cancers that are located in cosmetic areas where preservation of the maximum amount of normal skin is important. Physicians who have the training, surgical and laboratory facilities, and staff to perform this specialized technique practice Moh’s surgery.

WHY REMOVE SKIN CANCERS WITH MOHS SURGERY?
Some skin cancers are deceptively large-far bigger under the skin than they appear to be from the surface. These cancers may have cells that are tracking along blood vessels, nerves, or cartilage. Also, skin cancers that recur after previous treatments may send out extensions deep under the scar tissue that has formed. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous cells.

HOW IS MOHS SURGERY DONE?
There are three steps involved in Moh’s surgery:
1. The skin is made completely numb using a local anesthetic. The visible cancer is removed with a thin layer of additional tissue. This takes only a few minutes and the patient may then return to the waiting room. A detailed diagram (a Mohs map) of the removed specimen is drawn.
2. The specimen is color coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and under surface. These slices are placed on microscope slides and stained for examination under the microscope. This is the most time consuming part of the procedure, often requiring an hour or more to complete.
3. The doctor then carefully examines these slides under the microscope. This allows examination of the entire surgical margin of the removed tissue. That is, the entire under surface and the complete edge of the specimen is examined. All microscopic cells of the cancer can thus be precisely identified and pinpointed on the Moh’s map. If more cancer is found the doctor uses the Moh’s map to determine where additional tissue should be removed. This allows the Moh’s surgery technique to leave the smallest possible surgical defect because no guess work is involved in deciding where to remove additional tissue. Only tissue around the cancerous cells is removed.

HOW LONG DOES IT TAKE?
Most cases can be completed in three or fewer stages, requiring less than four hours. However, no one can predict how extensive a cancer will be because the size of a skin cancer sometimes can not be estimated in advance. Therefore you should reserve the entire day for surgery, in case additional surgical sessions are required.

WILL IT LEAVE A SCAR?
Yes. Any form of surgery leaves a scar. Moh’s surgery, however, will leave one of the smallest possible surgical defects, and therefore a smaller scar.

WHAT HAPPENS AFTER THE MOHS SURGERY IS COMPLETED?
When the cancer is removed, the doctor will discuss with you your options. These may include: 1) Allowing the wound to heal naturally, without additional surgery (often produces the best cosmetic result), 2) Wound repair by the doctor, 3) Wound repair by the referring physician or 4) Referral to another surgeon for wound closure.

WILL I HAVE PAIN, BRUISING, OR SWELLING AFTER SURGERY?
Most patients do not complain of significant pain. If there is discomfort, Tylenol is usually all that is necessary for relief. However, stronger pain medications will be prescribed when needed. You may have some bruising and swelling around the wound, especially if surgery is being done close to the eyes.

WILL MY INSURANCE COVER THE COST?
Most insurance policies cover the costs of Moh’s surgery and the surgical reconstruction of the wound. Please check with your insurance carrier for exact information relating to your surgery.

HOW DO I PREPARE FOR SURGERY?
Get a good night’s rest and eat normally the day of surgery. If you are taking prescription medications, continue to take them unless otherwise directed. However, avoid taking medications that contain aspirin for ten days before your surgery. Also please do not take any aspirin substitutes, such as Advil, Motrin Naproxyn, etc. within 24 hours of surgery. You may, however, take Tylenol at any time before surgery. You may want to bring a book or magazine with you to occupy your time while waiting for your slides to be processed and examined. It might be a good idea to arrange for someone to drive you home after surgery is completed.