What is Mohs micrographic surgery?

What types of cancers can benefit from Mohs Surgery?

 

Most skin cancers that develop on the head and neck can be treated with Mohs surgery. This includes basal cell carcinoma and squamous cell carcinoma, as well as some more rare tumors. It is especially appropriate for skin cancers in areas where tissue sparing is needed for cosmetic outcome or function, cancers that have recurred following previous treatments, are large or ill-defined, or develop in individuals with suppressed immune systems (organ transplant recipients and others).

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How long will it take?

 

This depends on the complexity of the skin cancer and the number of stages involved.  We endeavor to remove the skin cancer with as little healthy tissue as possible, and with the fewest number of layers or stages.  Most patients spend only a morning or afternoon with us, and we communicate with you along the way to ensure you stay in the loop.  You remain awake throughout the entire day and most people are able to drive after the procedure without difficulty (this primarily depends on how you are bandaged).

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Will it hurt?

 

We are all allergic to pain!  We work very hard to make you comfortable in every way, and this especially includes pain control.  We use the smallest needles in common production (30 gauge), and take our time with anesthesia.  We use longer acting agents as well as nerve blocks when these are appropriate to keep you as comfortable as we possibly can.  Most patients note minimal pain, and do not require narcotics for pain control.

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Will I have stitches? What will it look like? Will there be a scar?

 

Sometimes stitches are not required, but this depends on personal and surgical factors.  We will evaluate your wound together at the end of the cancer removal and discuss your options with you.  All cuts on the skin leave a scar to some extent, and it is important to make it as hidden as is possible.  For most people this involves a linear closure (a straight line) in an existing crease on the face.  Some people benefit from moving skin from a nearby source to cover the wound (a flap) or borrowing skin from a distant site (a graft).  This is a decision we will make together.  We perform the repair for more than 90% of our surgeries, and most patients prefer to have us repair their surgery wound.  Dermatology residency and in particular the Mohs fellowship involves a significant amount of complex reconstructive training, and this is in part why it is important to find a fellowship-trained Mohs surgeon and insist that they perform all aspects of your surgical care – start to finish!  Some patients prefer a plastic surgeon whom they already have a relationship with to repair their wound, and we are happy to work with them and you to coordinate this if this is your desire.  In some circumstances, the repair may also be beyond the capabilities of our office or scope of our practice and we will discuss this and be happy to help refer you to our wonderful surgical colleagues should this seem to be in your best interest.  You are our most important priority throughout this entire process, and we seek to have the best outcomes possible for you in terms of cure and cosmesis.