Mohs Surgery
A diagnosis of skin cancer can be frightening, particularly if it occurs on your face. A special surgical technique called Mohs Surgery is an effective method for treating many types of facial skin cancers.
What is Mohs surgery?
Mohs surgery, also called microscopically controlled excision, is named for Dr. Frederic Mohs, who developed it in the 1940’s. The procedure involves removing the skin cancer lesion along with some of the surrounding normal tissue. The normal tissue is examined immediately under a microscope to determine whether any cancer cells remain, and, if so, their exact location. If necessary, additional layers of tissue ae removed in succession until the area is free of cancer cells. Finally, the wound may be closed, using one of a number of surgical methods. Mohs surgery makes possible a high cure rate with a minimum loss of normal tissue.
Why is Mohs surgery important?
Skin cancers often send out slender strands of malignant cells into the surrounding normal tissue. In the past, surgeons would routinely remove or irradiate an extra margin of healthy tissue in the hope of eliminating all of the malignancy. But the cancer often would recur because of microscopic cells that were left behind.
The procedure is used to treat several different types of skin cancers, particularly recurring cancers and those that occur in what physicians call the “H” zone of the face – the nose and eyelids, the area around the ears and the temple areas. In these areas, it is essential to preserve as much tissue as possible so that cosmetically appealing results can be achieved.
Where is surgery performed?
Our Mohs laboratory is in Grove Place Surgery Center, a complete outpatient surgical facility, adjacent to our physicians office.
The Surgical Team
Dr. Proctor is trained in the Mohs technique and in facial plastic and reconstructive surgery. He is assisted by a laboratory technician who is skilled in preparing the necessary microscope slides. Several specialty trained nurses complete the surgical staff.
Preparing for Surgery
As a patient, you should not take any blood-thinning medication or products that contain aspirin for two weeks prior to Mohs surgery, as this will increase your tendency to bleed. You will be given a list of aspirin products to avoid. Be sure to let the doctor know if you are taking medication of any type.
On the morning of the surgery, wash with an anti-bacterial soap (such as Dial) and shampoo your hair. Eat a light breakfast and dress comfortably in clothes that do not need to be pulled over your head. Plan to arrive at the office 15 minutes before your scheduled surgery time. You may want to be accompanied by your spouse or friend to drive you home, especially if the cancerous area involves your eyelids. When you arrive, you will see the doctor for last minute questions. At this time you will give your written permission for the surgery.
If you are unable to keep your surgical appointment for any reason, please notify the office as soon as possible.
What to expect
The surgery takes place in a special treatment room designed for minor surgery. Your support person may accompany you into the operating room, if this makes you both comfortable.
A local anesthetic is injected to numb the surgical area. After the injection, most patients find the surgery virtually painless. Let the doctor know if you experience any discomfort.
It takes about 15 minutes for the surgeon to remove the first layer of cancerous tissue. You then will have to wait about a half an hour while the tissue is processed and examined.
If the exam reveals cancerous cells in the tissue sample, a second layer will be removed and processed. This step may be repeated two or three times, so that the full procedure will usually take from 2 – 5 hours.
After each excision, a sterile dressing is placed over the wound, and you may get up and sit in a chair or move around, if you wish. Feel free to bring a book, magazine, etc… to keep you occupied while you wait.
After all of the malignancy has been removed, the doctor will assess the extent of the wound and discuss with you what reconstructive treatment is necessary. If the wound is small and in a favorable location, it may be left to heal on its own. Frequently, a few stitches are all that is necessary. If a larger area is involved, a skin graft or flap procedure may need to be performed to reconstruct the area. In most cases, reconstructive treatment proceeds right after the Mohs surgery in and adjacent operating room.
Immediate Aftereffects
Most patients experience very little pain or discomfort following Mohs surgery. One should be careful driving if swelling of the eyes is expected.
The nurse will give you detailed instructions on how to care for the treated area. It is important that you follow these directions carefully to promote good healing.
Follow-up Visits
Regular follow-up visits are an important part of the treatment. If you have sutures, you will be given an appointment for one to two weeks after the surgery so that sutures can be removed. Additionally, Dr. Proctor may want to see you several times during the following year. It is recommended that you be checked yearly for five years following surgery to ensure there is no recurrence and no new facial skin cancers.
Long-term Results
Most Mohs surgery patients are very satisfied with the results of surgery. Remember, though, that the area needs to heal for some weeks before you will see the long-term results. In some cases, the scar may need to be revised later to allow better function or improve the appearance of the area. You should discuss any concerns you may have with Dr. Proctor.
Risks
There are potential risks with any surgery, but Mohs surgery is considered quite safe. Infection, bleeding, and bruising are possible risks, but rare. At times, the wound may be larger than anticipated or further surgery may be required to revise the scar. Recurrence of the cancer is relatively rare. Mohs surgery has a cure rate of 95 – 97 percent.
