Mohs Surgery

Mohs micrographic surgery is a treatment for skin cancer. Dr. Frederick Mohs at the University of Wisconsin developed it in the 1930's. This specialized surgical technique is often used to treat the two most common forms of skin cancer - basal cell carcinoma and squamous cell carcinoma. Of the available treatment options, Mohs surgery has the highest cure rate for these forms of cancer.

Description of Mohs Surgery

Mohs surgery is performed in several steps. First the surgeon marks the outline of the visible part of the skin cancer. Then the area to be treated is numbed with a shot of local anesthesia. Once the area is numb, the surgeon removes the cancer. Then the patient is bandaged and allowed to rest comfortably. While the patient waits, the removed skin is taken to the laboratory and processed into microscope slides. The surgeon then checks all of the edges and the under surface of the skin under the microscope to be certain that the skin cancer and all of its extensions or "roots" have been removed. If the cancer has been completely removed, then plans are made to repair the wound. If there is more skin cancer remaining, then the process is repeated, but only areas of skin with remaining cancer are removed. The surgery continues in this way until the cancer has been completely removed.

Repair After Mohs Surgery

Once the skin cancer has been completely removed with Mohs surgery, plans for repair of the wound are made. Many wounds can be closed with a simple line of stitches. Other wounds heal best if the body is left to heal naturally without further surgery. Some wounds may require a more complicated form of repair including flaps or grafts where skin is moved from nearby or distant sites to close the wound. Occasionally the Mohs surgeon may refer the patient to another surgeon for repair of the wound.

Benefits of Mohs Surgery

The main benefit of Mohs surgery is that it has the highest cure rate of any available treatment for most forms of skin cancer. This is because all of the edges and base of the cancer are checked under the microscope at the time of surgery. Cure rates range from 95-99% for cancers that have not been treated previously. The second benefit is that the size of the surgical wound is as small as possible because only the skin affected by the skin cancer is removed. This results in less chance of damage to important structures that may be near the cancer such as the eyes, nose and lips. It also means that the scar will be smaller once the surgical wound has healed.

Frequently Asked Questions

• How long will the surgery take?
  Most patients complete the process in about four hours. However, you should plan to spend the entire day at the clinic. Bring food and a book or something else to pass the time.
• Will there be a scar?
  There will be a scar. Generally the scar blends well with the surrounding skin. Care is taken during the surgery and afterwards to minimize the scar.
• Will the surgery be painful?
  There should be little to no pain associated with the surgery once the initial shot of local anesthesia is given. After the surgery, there may be some discomfort, but Tylenol is usually strong enough to take care of it.
• Where is the surgery performed?
  The surgery is performed in the clinic. It is generally not necessary to use a hospital operating room or a surgery center for Mohs surgery.
• How long do I need to be away from work?
  Most patients are able to resume normal light activities such as driving a car, working at a computer and walking the day after surgery. Patients are advised to avoid strenuous activities such as heavy lifting and vigorous exercise for at least one week after surgery.