Mohs Micrographic Surgery

What is Mohs Surgery?

Mohs surgery is named after Dr. Frederic Mohs of Madison, Wisconsin who developed this highly specialized technique for the removal of skin cancer over 70 years ago. In short, Mohs surgery is a way of removing the cancer one layer at a time and examining the tissue while you wait to make sure the entire cancer has been removed. Mohs is typically performed for basal cell carcinoma and squamous cell carcinoma.

Mohs surgery has three critical components:

Removal of the skin cancer
Review of the specimen under the microscope
Reconstruction of the defect

How is Mohs Surgery performed?

Mohs surgery is performed by dermatologists who have been formally trained in a 1-2 year program accredited by the American College of Mohs Surgery (ACMS). Always feel free to ask your doctor about his/her formal training and membership status with the ACMS.

Mohs surgery is performed in the office of Levy Dermatology, on an outpatient basis and under local anesthesia. After the area is numbed, all visible tumor is removed. After this, a thin layer of skin is taken with the scalpel. The tissue then is processed in the laboratory and examined under the microscope. Wherever tumor is found, another layer of skin is removed. This is continued until no tumor is present and the patient is cancer-free. Once the cancer has been removed, consideration for reconstruction of the wound will be made. The type of repair depends of the shape, size, depth, and location of the defect and usually occurs the same day as Mohs surgery, but occasionally may be delayed.

Why use Mohs Surgery?

Mohs micrographic surgery is considered the state-of-the-art treatment for skin cancer. For decades, Mohs surgery has proven effective in getting to the roots of skin cancer by combining the surgical removal of cancer with the immediate microscopic examination of the tumor and underlying diseased tissue. This process allows dermatologists trained in Mohs surgery to see beyond the visible disease and precisely identify and remove the entire tumor.

Of all treatment options for skin cancer, Mohs micrographic surgery:

Offers the highest cure rate (up to 99%)
Has the lowest chance of re-growth
Minimizes the potential for scarring or disfigurement
Is the most exact and precise means of removal

This technique is often preferred when the site of the skin cancer is an area where recurrence is likely as well as for larger tumors and for certain aggressive types of skin cancers. This delicate balance of removing all of the cancer cells while preserving as much healthy skin as possible is achieved by alternating surgical and diagnostic steps.

Mohs surgery is not always necessary. Smaller cancers in other areas of the body (such as the arms, thighs, or trunk) may be removed by standard excision (removal of the cancer with a safety margin). The cure rates of small, well-circumscribed skin cancers on the trunk and limbs are fairly good when compared to Mohs surgery.

Every skin cancer is different, and the decision on which method of treatment is most appropriate for your skin cancer is one that should be made carefully and with your dermatologic surgeon.

How is the wound reconstructed?

This will be addressed immediately after complete removal of the tumor is confirmed, usually on the same day. Sometimes the defect can be closed directly with sutures, sometimes a more advanced procedure utilizing a skin flap or graft is utilized, and sometimes the defect will heal nicely without any further treatment. Rarely, a staged repair requiring several additional procedures spread over weeks to months may be required. In almost all cases, the repair will be accomplished in our office, but in some cases it may be necessary to refer you for additional treatment by another specialist.

How should I prepare for Mohs Surgery?

For optimal healing after Mohs surgery and facial reconstructive surgery please take note of the following principles:

Quit smoking since smoking impairs healing after reconstructive surgery and can result in poor wound healing and scarring
Avoid medication and supplements that thin the blood (mainly aspirin, ibuprofen (e.g., Motrin®, Advil®), vitamin E, and fish oil) unless these are specifically prescribed for you by a doctor. Take any prescribed antibiotics as instructed. Please refrain from drinking alcoholic beverages three days prior to and three days after your appointment, since alcohol increases your risk of bleeding.
Eat your normal breakfast on the day of surgery
Avoid excessive lifting and physical activity after your surgery
Follow your post-operative instructions [link in WCInstructions.pdf] and ask if not sure about how to take care of your wound
Keep your follow-up appointments with Dr. Levy

Please try to arrive 15 minutes prior to your appointment to allow time for medical forms to be completed.

We suggest that you arrange to have a companion drive you to and from the doctor’s office. We do ask that you bring no more than one person with you to your appointment, so that there will be enough seating in the waiting room for everyone the day of your surgery.

We would like to make the time you spend with us as pleasant as possible. You may want to bring reading material to occupy your time while waiting for the microscopic slides to be processed and examined. Magazines, bottled water, and snacks will be available.

The most difficult part of the procedure is waiting for the results of the surgery. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you arrange to spend the better part of the day with us.

Do I need antibiotics prior to Mohs surgery?

Not usually. However, we recommend antibiotics 30 to 60 minutes prior to your surgery in the following situations:

if you have had joint replacement surgery within the past year;
if you have an artificial heart or heart valves;
if you have a history of endocarditis/infected heart valves; or
if you have severe dysfunction of a heart valve.

If you qualify for any of these situations, please call the office where your procedure will be performed at least two to three days before your appointment so we can prescribe an appropriate antibiotic.

Will there be much pain?

Your treatment will be carried out under local anesthesia (lidocaine) that blocks all pain. There will be some pain associated with the initial injection of anesthetic. There will also be mild to moderate pain beginning several hours after surgery and usually resolving over 24-48 hours. Acetaminophen is usually adequate for pain control. Ice packs to the surgical site, placed over the bandage are especially helpful for pain, swelling, and bruising.

How do I take care of the wound after Mohs surgery?

The dressing may be left in place 1-2 days depending on the type of repair. During this time, the area must be kept dry. After dressing removal, the area should be cleaned gently with hydrogen peroxide diluted 50:50 with water once daily and Vaseline ointment applied. Sutures are generally removed in 5-7 days. Click here for our wound care instruction sheet

How do I schedule Mohs surgery?

If you have a skin cancer and are interested in scheduling the Mohs surgery you may contact us to initiate the scheduling process. We can help set up the Mohs surgery for you as well the reconstruction of your Mohs defect with Dr. Levy.

Please call us at (901) 624-3333 to schedule your consultation.