Mohs Surgery

What is Mohs Surgery?

Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. Mohs surgery is also known as Mohs micrographic surgery.

The goal of Mohs surgery is to remove as much of the skin cancer as possible, while doing minimal damage to surrounding healthy tissue. Mohs surgery is usually done on an outpatient basis using a local anesthetic.

Mohs surgery is an improvement to standard surgery (local excision), which involves removing the visible cancer and a small margin of surrounding healthy tissue all at once. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery. This increases the chance of a cure and reduces the need for additional treatments or additional surgery.

Read more about : What is Basal Cell Carcinoma (BCC)?

Before Mohs Surgery

Why it's done

Mohs surgery is used to treat the most common skin cancers, basal cell carcinoma and squamous cell carcinoma, as well as some kinds of melanoma and other more unusual skin cancers.

Mohs surgery is especially useful for skin cancers that:

. Have a high risk of recurrence or that have recurred after previous treatment

. Are located in areas where you want to preserve as much healthy tissue as possible, such as around the eyes, ears, nose, mouth, hands, feet and genitals

. Have borders that are hard to define

. Are large or aggressive

Risks and Complications

As with any surgical procedure, Mohs surgery carries the risk of:

. Bleeding

. Pain or tenderness around the surgical site

. Infection

Other complications that may result from Mohs surgery are uncommon but may include:

. Temporary or permanent numbness surrounding the surgical area, if small nerve endings are cut.

. Temporary or permanent weakness of the surgical area, if the tumor is large and a muscle nerve is severed.

. Itching or shooting pain in the affected area

. An enlarged scar (keloid)

How you prepare

Selecting a Mohs surgeon

Mohs surgery can be technically challenging. Many skin doctors (dermatologists) can perform Mohs surgery, since dermatologists learn about Mohs surgery in their medical training. Some Mohs surgeons have undergone specialized training — called a fellowship — to learn more about the procedure and become more proficient in Mohs surgery.

Ask your doctor about his or her qualifications and experience performing Mohs surgery.

Preparing for surgery

Your surgeon may recommend ways you can prepare for your surgery. You may be asked to:

. Stop taking certain medications. Let your surgeon know of any medications or supplements you're taking, including any blood-thinning medications. Some supplements may affect your chances of bleeding after surgery, so make sure your surgeon knows about those, too. Continue taking any prescription medications as instructed unless your surgeon tells you otherwise.

. Clear your schedule for the day. It's not possible to predict how long Mohs surgery will take. For most people, the procedure takes less than four hours. But your surgeon may advise you to plan as though surgery will take all day, since there's a very small chance it could take that long.

. Wear comfortable clothing. Wear casual clothes that are comfortable. Dress in layers so you can easily adapt if the room is warm or cold.

. Bring something to help pass the time. Expect some waiting time during your Mohs surgery. Plan ahead by bringing a book, magazine or other activity to help you pass the time.

Read more about : Skin cancer treatment in Iran

During Mohs Surgery

What you can expect

Mohs surgery is done on an outpatient basis in an operating room or procedure room that has a nearby laboratory that allows the surgeon to examine the tissue after it's removed.

In most cases, the procedure lasts a few hours. But since it can be difficult to tell how extensive a skin tumor is just by looking at its surface, doctors often advise reserving the whole day for the procedure.

You likely won't have to change into a surgical gown unless the location of the tumor requires it. To prepare you for surgery, your surgeon or a nurse cleanses the area to be operated on, outlines it with a special pen and injects the area with a local anesthetic. The anesthetic numbs the skin, so you won't feel any discomfort during the procedure.

During the procedure

Once the anesthetic has taken effect, your surgeon uses a scalpel to remove the visible portion of the cancer along with a thin, underlying layer of tissue that's slightly larger than the visible tumor. A temporary bandage is placed on your incision. This takes only a few minutes.

The surgeon then takes this tissue to the laboratory for analysis. This portion of the procedure typically takes the longest amount of time.

Expect to wait about an hour or so in a waiting room for the surgeon to return. It may help to bring a book or magazine to pass the time. You'll be able to use the restroom or have a snack, if you need to, but you won't be able to leave the surgeon's office until the procedure is complete.

While you're waiting, the surgeon or technician cuts the tissue sample into sections and examines them with a microscope. Your surgeon takes great care to keep track of the exact spot where each piece of tissue was removed by making a map. That way, if a small area of cancer is found in one piece of tissue, the surgeon knows precisely where to continue with the surgery.

If cancer remains, your Mohs surgery will continue. Your surgeon removes an additional layer of tissue from the affected area, taking care to remove tissue that contains cancer while leaving as much healthy tissue as possible intact. Again, you'll wait while the surgeon examines the tissue in the laboratory.

The process is repeated until the last tissue sample removed is cancer-free. Local anesthetic can be re-administered as necessary.

Read more about : Bladder Cancer treatment

After Mohs Surgery

Recovery time for Mohs surgery

Recovery is usually very easy and uneventful. Overall, resting as much as possible the first few days after surgery is helpful.

Stitches (sutures) are usually removed at the surgeon's office anywhere from four to 14 days from the date of surgery. Your physician will let you know what date to return for stitch removal.

Most patients report minimal discomfort after surgery and require minimal or no pain medication.

If there is pain, many patients find that they prefer to take something for pain at the first hint of discomfort instead of waiting until the pain builds up to an unbearable level. If you have mild or moderate pain, your doctor may advise you to take acetaminophen (Tylenol) or another pain reliever over the counter. Aspirin or aspirin-containing pain relievers may cause increased bleeding. Rarely, prescription pain medications may be required for severe pain.

Your physician will let you know what pain medications are recommended for your specific condition.

Most patients are able to return to work or school the next day after Mohs. Avoiding heavy lifting, straining, or strenuous exercise for seven to 21 days may be required depending on the area of surgery. Your physician will need to let you know what activity precautions are required based on the area and size of your procedure.

You may go out in the sun with sunscreen and protective hats and clothing. Excess sun exposure has been linked to skin cancer. Use of sunscreen or other cover-up on the scar is very helpful for at least six months after surgery to help minimize scarring. It is important to follow your own physician's instructions for wound care and sun protection.

How do I take care of my surgical area after Mohs surgery?

It is recommended to check with your surgeon for specific postoperative wound care instructions. Often, you will be asked to go home and take it easy for the rest of the day. A few patients like to return to work and resume their work the day after surgery. It may be advisable to avoid heavy lifting and exercise, especially the first 24-48 hours after surgery.

Your physician will usually give you more detailed instructions depending on the area and size of the surgery. You will have usually have a bulky "pressure" dressing on the surgery area for one day. You may be asked to keep the area dry for 24 hours. Swimming pools, oceans, and Jacuzzis are usually not permitted while the stitches are in. These may increase your chance of infection. Many physicians allow you to shower the next day after surgery. Wound care may require cleaning the wound with soap or hydrogen peroxide two to three times a day and applying petroleum jelly to the area.

Mild swelling is not uncommon the first day or two after surgery and can be lessened by use of an ice-bag application, ice cubes or chips in a small Ziploc baggie, or frozen peas in the bag. Leaving the dressing in place, use cold pack application every five to 15 minutes every hour for the first eight to 24 hours after surgery. Swelling is more common for surgeries around the eyes or lips. Sleeping propped up on a few pillows or in a reclining chair may help decrease swelling after surgery of the head and face area.

The surgical area may ooze a little blood or clear liquid especially in the first few hours after surgery; activity may aggravate this. Hot drinks or bending over at the waist can also initiate or worsen bleeding of face wounds. If bleeding occurs, firm pressure applied directly to the site for 10-15 minutes may be helpful. Most bleeding will stop if you apply enough pressure. Your surgeon should be notified if bleeding persists. Rarely, a visit to the hospital emergency room may be necessary for severe bleeding.

Your surgeon will need to know if pain is increasing after one to two days after your surgery or if you are having fever or other concerning symptoms. In such cases, you may need to be seen at the surgeon's office. The surgical area may need to be checked for bleeding or infection. Limiting hot foods, hot drinks, and heavy chewing for 48 hours may help decrease the chances of postoperative bleeding for wounds around the mouth or cheek areas. Your physician will explain recommended wound care.

Most patients are advised to try to avoid applying makeup or powder directly on a fresh wound unless the surface is fully healed. Skin-colored tape strips called Steri Strips are available to minimize wound leakage and help cover up a visible wound. It is important to follow your physician's instructions for wound care.

Results

One of the advantages of Mohs surgery is that you know your results right away, and you usually don't leave your appointment until all of the skin cancer has been removed. You may have a follow-up visit with your surgeon or referring doctor to monitor your recovery to make sure your wound is healing properly.

Follow-up exams to look for additional skin cancer

Though Mohs surgery has a high rate of cure for skin cancer, you will always have a small risk of cancer recurrence or of developing another skin cancer.

People who have been diagnosed with skin cancer have an increased risk of developing skin cancer again, compared with people who have never had skin cancer. As many as half the people diagnosed with the most common types of skin cancer will develop another skin cancer again within five years.

Plan to undergo regular follow-up visits with your dermatologist or family doctor to spot any new skin cancer. Ask your dermatologist to create a follow-up schedule for you. How often you'll undergo follow-up skin exams depends on your diagnosis. Expect to have skin exams at least once or twice a year, and more often if your cancer was aggressive or is more likely to recur.