What is Mohs surgery?

Mohs micrographic surgery, commonly referred to as Mohs surgery, is the most effective treatment for treat basal cell and squamous cell carcinomas. 

The surgery can only be performed by dermatologists or surgeons trained in the specialized technique. During Mohs surgery, your surgeon will remove layers of tissue, examine the tissue for cancerous cells and repeat the process until the tissue is cancer free. The advantage of this surgery over other skin cancer surgeries is that your doctor will remove only the tissue necessary to successfully remove the skin cancer.

Who is a candidate for Mohs surgery?

Patients who fit into one of the following categories may be candidates for Mohs surgery:

  • Aggressive basal cell carcinoma or squamous cell carcinoma 
  • Basal or squamous cell carcinoma that does not have much tissue beneath it such as the hand, foot, eyelid, ear, nose, scalp or genitals
  • A rare skin cancer such as extramammary Paget’s disease or Merkel cell carcinoma
  • Early stage melanoma

Risks of Mohs surgery

Although complications associated with Mohs surgery are minimal, they can occur, so it is important to educate yourself with the potential risks before surgery. 

Your doctor will outline the benefits and risks of Mohs surgery during a clinic visit before scheduling the procedure. Complications associated with Mohs surgery can include:

  • Scar at the incision site
  • Large wound left after a large tumor is removed
  • Excessive bleeding
  • Infection at the wound site
  • Damaged nerves 
  • Tumor regrowth
  • Poor wound healing 
  • Cosmetic abnormalities from surgery - most common in areas such as eyes, ears, nose

What to expect during Mohs surgery

Most patients who need Mohs surgery can be treated in a doctor’s office. You will be awake during the procedure. Your doctor will inject a local anesthesia to numb the affected area. 

During Mohs surgery, your surgeon will remove cancerous tissue in stages. The surgeon will remove a layer of tissue and evaluate the cells under a microscope to see if the tissue contains cancerous cells. If the tissue contains cancerous cells, another layer of tissue is removed and examined. These steps are continued until a tissue sample shows no signs of cancer. Although the process is lengthy, it helps minimize disruption to healthy tissue.

Once your tissue sample is clear of cancerous cells, your doctor may stitch or treat your wound. Some patients may need a skin graft to maximize healing.

Recovery from Mohs surgery

Most patients go home after Mohs surgery but will be advised to rest for the remainder of the day. Many patients resume work the day after surgery, but some patients need a few days to recover. You will be advised to avoid exercising or heavy lifting for a couple days after surgery. 

Upon discharge, your doctor will give you detailed instructions on:

  • How to care for your wound
  • Activities to avoid such as swimming pools, lakes, oceans or Jacuzzis while stitches are in to avoid infection
  • Side effects and when to call your doctor 
  • Pain management techniques 

Results from Mohs surgery

There is a high cure rate for patients who have basal cell or squamous cell carcinoma treated with Mohs surgery. Cure rates are as high as 99 percent for new skin cancers and as much as 95 percent for recurring skin cancers.

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