Mohs Surgery

Mohs surgery is a highly effective, specialized technique for removing skin cancers. The technique was developed in the 1930s by Dr. Frederick Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other forms of skin cancer treatment in that it allows for the immediate and complete microscopic examination of the removed cancer tissue so that all roots and extensions of the cancer can be eliminated. Mohs surgery has the highest reported cure rate of all treatments for skin cancer.

Treating all skin cancers with Mohs 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 for cancers that are located in cosmetic areas where preservation of the maximum amount of normal skin is important.

How is Mohs surgery done?

There are three steps involved in Mohs 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 only takes a few minutes and the patient may then return to the waiting room.
2. The specimen is color coded to distinguish top from bottom and left from right. A technician freezes the tissue and cuts very thin slices from the entire edge and undersurface. 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 45 minutes or more to complete.
3. The doctor then carefully examines the slides under the microscope. The entire undersurface and all edges are examined. All microscopic roots of the cancer can thus be precisely identified and pinpointed.

If more cancer is found on the slides, the doctor then removes additional tissue only where cancer is present. This allows the Mohs surgery technique to leave the smallest possible surgical defect because no guesswork is involved in deciding where to remove additional tissue. Only tissue around the "roots" and extensions of cancer is removed.

Finally, the wound that was created will be closed. The way in which this is done varies depending on the site and size of the wound, and involves placing sutures. Sometimes the wounds are left open to heal naturally.The doctor will discuss the options with you prior to repairing the wound.

Preparing for Mohs surgery

DO:

• Eat a normal meal before surgery
• Tell your doctor if you have any allergies to medicines, have a bleeding problem or require antibiotics prior to any surgical procedures
• Bring something to read since you will be spending several hours in the office

DON'T:

• Don't wear any make-up or jewelry the day of the surgery.
• Don't have alcohol from one week before to one week after the surgery.
• Don't take vitamin E, niacin, fish-oil tablets, ginko or other herbal supplements for one week before to one week after the surgery. These can thin the blood and increase bleeding during the procedure.
• Don't take aspirin, Motrin, Advil, Aleve, Ibuprofen, Nuprin or other pain relievers other than Tylenol for one week before to one week after the surgery. These can thin the blood and increase bleeding.
• Don't have caffeine (coffee, tea soda) the day of the surgery.
• Don't smoke excessively (it slows healing). It's best not to smoke at all. Do not smoke within two hours of the surgery.

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Skin Cancer

Skin cancer refers to the abnormal, uncontrolled growth of skin cells. One in five people will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Risk factors include pale skin, family history of melanoma, being over 40 years old, and regular sun exposure. Fortunately, skin cancer is almost always curable if detected and treated early.

The most common skin cancers are:

1. Basal cell carcinoma - 80-85% of all skin cancers. Basal cell carcinoma affects cells in the lowest layer of the epidermis.
2. Squamous cell carcinoma - 10% of all skin cancers. Squamous cell carcinoma affects cells in the middle layer of the epidermis.
3. Melanoma - 5% of all skin cancers. Melanoma is a rare but very dangerous type of skin cancer. It is the leading cause of death from skin disease.

Skin cancers vary in shape, color, size and texture, so any new, changed or otherwise suspicious growths or rashes should be examined immediately by a physician. Early intervention is essential to preventing the cancer from spreading. 

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