Here are answers to some of the most common questions patients ask about Mohs surgery.
This unique form of surgery for skin tumor removal was developed more than 50 years ago by Frederick Mohs, MD, a professor at the University of Wisconsin. Since that time, the technique has been refined and advanced. In fact, today it is offered in most major medical centers throughout the country. Its wide acceptance stems from the fact that, for certain kinds of skin cancer, it offers a cure rate of upwards of 99 percent.
Mohs surgery is performed by a specialty trained team that includes a physician, several surgical assistants, a technician who prepares the tissue for microscopic examination, and the office staff. You will meet the entire team at the time of your consultation and/or surgery.
Mohs surgery is performed on an outpatient basis. First, local anesthesia is used to numb the tumor site. Then, as much of the visible tumor as possible is taken off by scraping with a special instrument. A thin layer of skin at the tumor site is then removed and examined under a microscope. If evidence of tumor cells is found at the edges of the sample, the doctor will remove and examine another skin sample. These steps will be repeated until no tumor can be detected under microscope. Depending on the extent of the tumor, this process may be repeated several times. Although the actual surgery involved in each sampling takes only 20 minutes, the entire process may take upwards of one hour per sample. As we cannot determine ahead of time how many stages you will require, be prepared to spend the entire day with us. It very rarely takes more than one day to remove a tumor.
The major advantage of Mohs surgery is that by tracking the tumor-removal process microscopically, we better ensure that the entire tumor is removed. Another important advantage of this technique is that by using a microscope to guide us, we remove only the tissue which the tumor has already invaded, sacrificing little of the surrounding healthy skin. This is important if the cancer is close to an important feature, especially on the face. Of course, any procedure will leave a scar, but by preserving the maximum amount of healthy skin, we strive to allow the best possible cosmetic result.
We cannot know ahead of time the extent of your tumor. It is difficult, therefore, to discuss the repair of the surgical site until the procedure is completed. However, there are several ways of repairing the skin. Small or superficial wounds may be left to heal by themselves. Larger wounds may need to be stitched closed. The largest wounds may require a flap or a graft. Both techniques involve moving healthy skin from elsewhere on your body to repair the surgical wound. When the tumor has been completely removed, and we know the size and shape of the resulting wound, we will be better able to discuss the best options for repair. Most patients have their wound repaired on the same day the Mohs procedure is performed.