Mohs Surgery

What is Mohs surgery? 

Mohs micrographic surgery is a technique that was invented in the 1930s by Frederic Mohs, MD.  Micrographic refers to the use of a microscope to create a map of a tissue specimen, any remaining tumor, and any additional histologic (microscopic) findings to aid precise tumor removal.  Training is received in this technique, as well as advanced reconstruction, through a 1-2 year additional fellowship after completing a residency in dermatology. Using this map, the smallest amount of tissue is taken while still ensuring all cancerous cells are removed. 

What are the benefits of Mohs surgery?

Because the tissue can be examined immediately, significantly less normal tissue needs to be sacrificed when performing Mohs surgery in order to assure complete removal.  This ultimately results in a smaller surgical defect and the potential for a less extensive repair.

The tissue processing technique of Mohs micrographic surgery allows for examination of 100% of the surgical margin,  A complete examination of the margin results in the highest cure rate, and the highest confidence that the cancer is completely removed.  High confidence of cancer removal means that advanced reconstructive techniques can be used to repair the surgical wound, such as skin flaps that sometimes help to improve the cosmetic results by camouflaging scar lines.  

Slow Mohs

“Slow Mohs,” is a staged surgical excision with comprehensive margin evaluation or a modified version of Mohs surgery, that is used for certain types of skin cancer, primarily melanoma in-situ (limited to the epidermis, the top layer of skin). Special stains that require a longer processing time are used to look for malignant cells at the tissue margins, as these can be more difficult to identify than the cancerous cells of non-melanoma skin cancers.

How do I know if I need Mohs surgery?

The main consideration for Mohs is the anatomic location. As it is a tissue-sparing technique, it should be used on sites where there isn’t a lot of ‘wiggle room’ like the head and neck, hands, feet, genitals, or even the fronts of the lower legs. Other considerations include large and fast-growing skin cancers, recurrent cancer, or patients who are poor surgical candidates for other more invasive surgical techniques.  

After reviewing the pathology results from your biopsy, your dermatologist may recommend Mohs surgery. Depending on the case, Dr. Gillen or Dr. Callahan may see you for the first time on the day of your surgery, or if you would prefer to discuss whether Mohs surgery is the right option for you, a consultation with your surgeon is advised and can be scheduled. They will see you for suture removal (if necessary) and in follow-up for any additional issues arising with the cancer that was treated. Still, you will return to your general dermatologist for ongoing monitoring, skin checks, and additional dermatologic care.

Why do I need Mohs if my skin cancer looks like it’s gone after the biopsy?

A biopsy is a diagnostic procedure. That is, a biopsy is always performed to make a diagnosis and is generally not intended to treat a lesion or condition. Most frequently, only a small portion of a lesion is sampled by a biopsy. After your biopsy, a scar will usually form, hiding any deeper portion of the cancer that was left. This residual cancer can continue to grow under the scar and may go undetected for quite some time if not treated promptly, allowing the cancer to invade more deeply or involve a larger area of skin. This ultimately will result in a more extensive removal surgery and likely a more complex reconstructive procedure. If a biopsy shows skin cancer and the procedure intended to make a diagnosis only, the lesion should be treated definitively.

After Mohs, will I have a scar or pain? Will I have bruising? 

Unfortunately, scarring is inevitable anytime an incision is made into the skin. However, using the tissue-sparing technique of Mohs surgery and the advanced reconstruction techniques Dr. Gillen and Dr. Callahan have mastered, the scar will be as cosmetically appealing as possible. Additionally, the wound care instructions given by the team at Absolute Dermatology & Skin Cancer Center will provide your wound with an optimal environment for healing. Unlike scarring, which is permanent, bruising and swelling and pain may also occur, but are transient and will resolve. Patient medical history and prescriptions can affect these factors and will be kept in mind as our expert team determines the best plan for you, including the recovery process. 

What are my limitations after Mohs? Can I return to work? Can I Exercise? Can I drink alcohol? 

After surgery, you will generally require a bandage for at least one week. You should plan to take the entire day off of work and take it easy for the next week. Some patients may even want a driver if the site of surgery is near the eye and may impede their vision, or if they require medications to relax. 

The first 48 hours are the highest risk for bleeding, so while you can work at a computer (with a bulky bandage at your surgery site), you shouldn’t exercise or drink alcohol as these can increase your risk of bleeding at your surgery site. As the initial bandage needs to stay in place for these first 48 hours, you might need to avoid showering. 

Additionally, you should avoid smoking of any kind for at least one week before and after your surgery. Smoking decreases blood flow to the skin and impairs the healing response, leading to a suboptimal cosmetic result. 

To schedule a Mohs surgery consultation with William Gillen, MD or Dr. Shields Callahan, MD at Absolute Dermatology & Skin Cancer Center, call the office or send us a message to book an appointment on our contact page.

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