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Mohs surgery, also called Mohs micrographic surgery, is a specialized
technique for removing skin cancer. Named after its inventor, Dr.
Frederic Mohs, Mohs surgery is the treatment of choice for many
skin cancers on the head and neck. It offers the following advantages:
- Highest cure rate. Because all surgical margins are examined
microscopically in the office, this procedure has the highest
cure rate of all skin cancer treatments.
- Optimal cosmetic result. Because there is no need to
take a margin of healthy skin in Mohs surgery, the size of the
wound left after tumor removal is minimized. Keeping the defect
small optimizes the surgical repair, and produces a superior cosmetic
result.
| Watch a 9 minute video about the basics of skin cancer and the Mohs surgery process. The video was produced by the American College of Mohs Surgery. (23.6 MB) |
Mohs surgery is as an outpatient procedure that is performed under
local anesthesia. First, the portion of the tumor that is clearly
visible is surgically removed. Then the tumor is processed by the
laboratory located in the office. This processing takes about an
hour. After processing, the physician uses a microscope to see if
the entire tumor has been removed. If the margins are clear, and
the tumor has been completely removed, then the surgeon repairs
the wound left from tumor removal, which usually involves sutures.
If the margins are not clear, meaning that some of the tumor was
left behind, then the surgeon will go back and remove the edges
around the previous tumor. This will likewise be processed and examined
with a microscope. If tumor removal is complete, then sutures will
be used to repair the defect, if not, then they will need to go
back for more. This process is repeated as many times as necessary
until the entire tumor is removed.
Because the number of stages involved with each case is unpredictable,
it is impossible to know how long the surgery will take. For this
reason, it is important for patients to plan on spending the entire
day with us. Bring a good book and whatever else will help keep
you comfortable while you are with us.
Are skin cancers life-threatening?
The two most common types of skin cancer, basal cell carcinoma and
squamous cell carcinoma, are rarely life threatening. These tumors
replace normal surrounding tissue and generally do not spread to
other areas. The third most common skin cancer, malignant melanoma,
can be life threatening if treated late. When discovered and treated
early, malignant melanoma is curable. Basal cell carcinomas and
squamous cell carcinomas never "turn in to" malignant
melanoma.
What does "Mohs" stand for?
Dr. Frederic Mohs developed this technique about 60 years ago. The
procedure has been modified and refined over the years. Practitioners
of the technique have kept Dr. Mohs’ name in respect for his
contribution. Mohs surgery has other names including Mohs chemosurgery,
Mohs microscopically controlled surgery, and Mohs micrographic surgery.
How large of a scar will I have from the surgery?
The size of the scar depends on the size of the tumor. It is often
difficult to predict the size of the tumor prior to surgery.
Will I have stitches following the surgery?
Most patients will have stitches. There are three main ways your
surgical wound may be handled:
- Direct closure of wound with stitches. This is the most common
method.
- Skin graft or flap: In some instances, it is necessary to remove
skin from behind the ear or some other site and graft it over
the wound. Other times skin that is located near the wound is
moved in to fill the defect left from surgery – this is a
skin flap.
- Let wound heal in by itself. The body has an excellent capacity
to heal open wounds. This healing period is approximately three
to six weeks depending on the size of the wound. It requires regular
wound care.
In addition to wound size and location, the surgeon considers other
factors to determine how your wound will be handled. This will be
fully discussed with you on the day of surgery.
Will I be put to sleep for the surgery?
No. The surgery is well tolerated with local anesthesia. Because
the surgery may be time-consuming, the risk of prolonged general
anesthesia is thus avoided.
How long will the surgery last?
The length of surgery depends on the extent of the tumor. Often
surgery lasts half a day or longer. Much of the time is spent waiting
for tissue to be processed. Bring reading materials, needlework,
etc., with you to help pass the time. Also, bring a snack or lunch
with you on the day of surgery. A refrigerator and microwave oven
are available for your convenience.
What if I live far away from the Skin Cancer Center?
If your travel distance is great you might want to spend the night
before surgery in the Sterling area. There are several moderately
priced motels nearby. A list of these is available upon request.
Should I bring someone with me?
Yes. It is essential that you bring someone along as you will be
unable to drive after surgery. Someone other than the patient must
perform postoperative wound care in many instances. The nurse can
give this person direct instructions, demonstrate wound care, and
answer any questions after the surgery.
What should I wear?
You should wear comfortable clothing. Men should wear a shirt, which
buttons down the front. Women should wear a blouse, which buttons
down the front and a skirt or slacks.
Should I eat breakfast before surgery?
Yes. Breakfast is recommended.
Should I take my regular medications on the morning of the surgery?
Yes. Take your regular medications as they have been prescribed.
Are there any medications I should avoid prior to surgery?
If you take aspirin on a regular basis, you should discuss this
with Dr. Todd prior to your surgery. In some instances it is beneficial
to stop your aspirin 10 days prior to surgery. However, you should
not stop it without talking to your physician first. If you are
on coumadin, please continue taking it as prescribed. Also, bring
a list of your medications with you on the day of surgery.
Will my activity be limited after surgery?
Yes. Plan on being out of work for several days after surgery. If
your work requires significant physical exertion, you may be out
of work longer. An excuse for your absence will be provided if necessary.
Avoid any long trips within the first ten days following surgery
in case you develop some complications.
What are the potential complications of surgery?
Bleeding and infection are the two primary complications. Both of
these are uncommon, and can be treated if they do occur. We will
discuss how to recognize and deal with these problems when you come
for your surgery.
Will my insurance cover the cost of surgery?
Under most circumstances your carrier will pay for surgery. If you
are a member of an HMO, it may be necessary to obtain a referral
or authorization from your primary physician. If you are in doubt
about your particular coverage, it would be useful to check with
your insurance representative prior to your appointment. If you
have specific questions regarding insurance or billing matters,
please contact our office at (703) 723-5700.
Learn more about Mohs surgery from:
American College of Mohs Micrographic Surgery and Cutaneous Oncology
www.mohscollege.org/AboutMMS.html
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