Mohs Surgery – A Micrographic Procedure For Skin Cancer

Despite nationwide skin cancer campaigns preaching the benefits of sunscreen and skin exams, skin cancer ranks No. 1 as the most common form of cancer in the United States. A skin cancer diagnosis often catches people off guard, especially in later decades, but Mohs surgery has transformed the way dermatologists treat common skin cancers.

Mohs surgery, a highly precise and specialized outpatient procedure, is the gold standard for removing appropriate basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). These are the most common types of skin cancer, and both have been linked to harmful damage from the sun’s ultraviolet (UV) rays and the use of UV tanning beds.

If you have been diagnosed with skin cancer, it can be scary. The good news is that most skin cancers are treatable if caught early. That is why it’s important to see your dermatologist regularly and stay alert for unusual moles, sunspots, or abnormal growths.

What is Mohs Surgery?

Mohs surgery is the leading treatment for skin cancer, most often used to treat basal and squamous cell carcinomas as well as more rare tumors in select locations including melanoma, the most dangerous of the three.

Completed in a single visit, Mohs surgery is both cost-effective and efficient. The success rate is the highest of all treatments for skin cancer – up to 99 percent – and is effective even when other forms of treatment have failed.

APDerm has 11 dermatologists trained to perform Mohs surgery. Physicians must complete a residency in dermatology to be eligible for additional fellowship training in Mohs micrographic surgery.  Fellowship-trained Mohs surgeons are not only trained in skin cancer removal, they are also trained in advanced facial reconstruction.

Mohs surgery relies on precision and accuracy.  Initially, the Mohs surgeon removes clinically apparent tumor with narrow margins.  The tissue is then processed and the surgeon is able to evaluate the entire deep and peripheral tumor margins under a microscope.  By directly visualizing the skin cancer the Mohs surgeon can see beyond the visible disease, identify and remove the entire tumor, and leave healthy tissues unharmed.

Advantages include:

• Your dermatologist serves as surgeon, pathologist, and reconstructive surgeon all in one visit.
• Highest cure rate for treating appropriate basal and squamous cell carcinomas.
• Outpatient procedure utilizing local anesthesia that is minimally invasive and done in stages while you wait.
• Most precise method of tumor removal of available treatments.
• Surgeon examines removed tissue for evidence of cancer that is not apparent on visual inspection of the skin.
• Minimizes the chance of tumor recurrence while sparing healthy tissue.
• Advanced reconstruction reduces the risk of scarring or disfigurement.
• You leave the office knowing that you are cancer-free.

What to expect during the Mohs procedure

Mohs surgery involves surgical removal of the affected skin and lab analysis. After removing the growth or top layer of tissue, your doctor examines it under a microscope. He or she looks for signs that cancerous tissue remains by tracing the tumor growth using a map of the surgical site.

While high-tech, the tissue preparation and microscopic evaluation can take some time. If any cancer cells remain, they are marked on a map, and your doctor removes another layer of tissue from the affected area. The process repeats – as many times as is needed – until you’re deemed cancer-free.

The procedure can take up to several hours if more than one or two rounds are needed, however it’s important to make sure all the cancer cells are gone. An effective Mohs surgery reduces the need for additional treatments and the chance that skin cancer will return in that spot.

Other tips for getting prepared:

• Let your doctor know about any changes in your health or medications and supplements you’re taking, particularly blood-thinning medications.
• Try to relax and clear your schedule so you don’t feel rushed to get back to work or school.
• Eat prior to your surgery unless otherwise indicated by your surgeon.
• Wear comfortable clothing with easy access to the affected area, especially if you plan to keep them on during the surgery.
• Bring something to pass the time. You may have to wait while your doctor examines the pathology results or in between rounds of treatment.
• Consider asking a friend or family member to drive you to and from surgery.

Is Mohs surgery right for you?

Your doctor will determine if you are a good candidate for the surgery. In general, Mohs surgery is recommended if:

• Cancer is in a delicate and highly visible area, such as eyelids, nose, ears, lips, finger, toes or genitals
• Cancer was previously treated and has recurred.
• Cancer is very large or has indistinct borders.
• Scar tissue exists around the cancer.
• Patient and doctor want to preserve healthy tissue for maximum functional and cosmetic results
• Cancer is rapidly growing or of a particularly aggressive subtype

Once the procedure is completed, your doctor may recommend leaving it open to heal or close it with stitches. It’s important to follow your doctor’s guidelines for post-op care of the wound to minimize scarring or other complications.

In more complicated cases, the skin may need reconstruction by rearranging neighboring tissue (referred to as a flap closure) or possibly a utilizing a skin graft taken from an area of healthy skin.  In most cases your surgeon will perform the complex reconstruction, with the exception of select cases where you may be referred to a plastic surgeon, oculoplastic surgeon, or hand surgeon.

All those years of sunbathing, or using a tanning bed in your teens, can have dire consequences if skin cancer isn’t caught early. An unassuming mole can turn deadly, which is why it’s important to wear sunscreen, perform regular skin self-exams, and see your dermatologist for any new changing spots.

APDerm offers a variety of medical, cosmetic, and surgical dermatology services. Highly trained board-certified dermatologists provide professional care and work with you to develop the best treatment plan. Contact APDerm to learn more about Mohs Surgery or schedule a consultation today!

Author: Dr. Julia Baltz

Dr. Baltz is a Board-Certified Dermatologist with Dermatology Professionals and APDerm. She is fellowship-trained in Mohs Micrographic Surgery and her areas of interest include Mohs surgery, complex reconstruction, cosmetic dermatology, as well as nail disorders and nail surgery. She practices dermatology in APDerm’s North Attleboro, MA and East Greenwich, RI locations.