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What is Mohs Micrographic Surgery?
The Most Effective Treatment For Skin Cancer
Developed by Dr. Frederick Mohs, Mohs micrographic surgery is a specialized, highly effective technique focusing on the accurate removal of skin cancer. It allows the best tracking of the skin cancer (by visualizing 100% of the surgical margins), while sparing the greatest amount of surrounding healthy tissue.
Mohs surgery provides the highest cure rates (up to 99%) for basal cell and squamous cell carcinomas when compared to any other method. The surgeon then performs reconstruction of the defect. There is no need to go to a surgical center or hospital, and the patient can go home the same day.
There is also no need for general anesthesia, preventing a lengthy recovery and possible side effects from general anesthesia. Mohs surgery is recommended for recurrent skin cancers or skin cancers where maximum preservation of healthy tissue is vital, such as the face, hands, feet, and genitals.
Mohs surgery provides the highest cure rates (up to 99%) for basal cell and squamous cell carcinomas when compared to any other method. The surgeon then performs reconstruction of the defect. There is no need to go to a surgical center or hospital, and the patient can go home the same day.
There is also no need for general anesthesia, preventing a lengthy recovery and possible side effects from general anesthesia. Mohs surgery is recommended for recurrent skin cancers or skin cancers where maximum preservation of healthy tissue is vital, such as the face, hands, feet, and genitals.
1) Local anesthesia is injected to numb the area completely, and the visible portion of the tumor is removed.
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2) The first layer of tissue with a narrow margin around the tumor is surgically removed. The wound is bandaged temporarily while lab work begins.
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3) The surgeon cuts the tissue into sections, color codes them with dyes and draws a map of the surgical site. In the lab, the divided tissue is frozen and very thin horizontal slices are cut, placed on microscope slides and stained for examination.
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4) The undersurface and edges of each tissue section are examined under a microscope by the surgeon for evidence of remaining cancer.
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5) If cancer cells are found under the microscope the surgeon marks there location on the "map" and returns to the patient to remove another layer of skin- but only from precisely where the cancer cells remain. This process is repeated until there is no evidence of cancer remaining.
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6) The wound may be left open to heal or closed with stitches, depending on its size and location. In most cases the surgeon will repair the wound immediately after obtaining clear margins. In some cases, the wound will need reconstruction with a skin flap where neighboring tissue is moved into the wound or possibly a skin graft. In some cases, your Mohs surgeon may coordinate repair with another specialist.
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© American College of Mohs Surgery 2017- All Rights Reserved
What Skin Cancer Qualifies For Mohs Surgery?
Mohs surgery is indicated for high risk skin cancers with the following features:
- High risk location (such as head, neck, hands, feet, genitalia) where preserving cosmetic appearance and function are essential
- Large tumors (>1cm on head, >2cm on trunk)
- Recurrent skin cancers that have been previously treated
- Poorly defined margins
- Located in scars, burns, or previous sites of radiation therapy
- High risk tumors that are painful, rapidly growing, or invading nerves
- Aggressive histologic (microscopic) patterns
- Incompletely excised tumors
- Skin cancer in immunosuppressed patients (cancer or organ transplant patients)
See the American College of Mohs Surgery, the American Academy of Dermatology, or American Academy of Family Physicians for more information. [1]
Post Operative Care
The surgeon will determine the optimal option for wound healing, which include:
- Allowing wound to heal naturally without the use of sutures or follow-up surgeries.
- Repairing the wound with sutures. Sometimes, skin grafts or flaps from other areas may be used for larger wounds.
- Referring to another reconstructive surgeon depending on the size, depth and location.
- Even with the highest cure rate (up to 99%), there is still a possibility of recurrence with Mohs surgery.
- Scarring, bleeding, infection, nerve injury, or medication side-effects.
- Please ask our office for the Mohs Surgery Consent form for the full list of risks.
Mohs Surgery Facts
1 PriceThanks to Mohs surgery high sucess rates, most patients only require a single surgery- far less costly than other methods, which can require multiple surgeries and multiple fees.
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1 DayAlthough Mohs surgery is an outpatient procedure, the process can last several hours, depending on the extent of your condition. Play it safe and clear your schedule on surgery day.
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High Cure RatesMohs surgery has a cure rate of up to 99% for primary tumors and up to 94% on recurrent tumors, but it is still important to keep up with regular skin checks and follow-up appointments after surgery.
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1 YearIn some cases, it can take up to a year for your surgical site to fully heal. If you have a scar expect it to flatten significantly and fade in color during this time.
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4 Reconstruction OptionsThere are 4 main options for reconstruction after Mohs surgery, ranging from letting incision heal on its own to (rare) reconstructive surgery. Your Mohs surgeon will help you determine what's best.
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1 OrganizationThe American College of Mohs Surgery requires rigorous training as a condition of membership. By choosing a fellowship-trained Mohs surgeon, you're making the best desicion for your long term health.
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References:
- Why Does My Cancer Need Mohs Surgery?” Mohs Surgery Patient Education by American College of Mohs Surgery. 2 March 2017. www.skincancermohssurgery.org/about-mohs-surgery/why-does-my-cancer-need-mohs-surgery .
- Connolly, Suzanne M., et al. “AAD/ACMS/ASDSA/ASMS 2012 Appropriate Use Criteria for Mohs Micrographic Surgery: A Report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery.” Journal of the American Academy of Dermatology. October 2012. Volume 67, Issue 4. pp. 531–550. doi:10.1016/j.jaad.2012.06.009.
- Bowen, Glen M., et al. “Mohs Micrographic Surgery.” American Family Physician. American Academy of Family Physicians. 1 Sept. 2005. https://www.aafp.org/afp/2005/0901/p845.html.
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