What Is Mohs Surgery?
Mohs micrographic surgery is a highly specialized surgical procedure to precisely map and remove skin cancers while preserving as much healthy skin as possible.
The Mohs surgeon utilizes microscopic guidance to remove the skin cancer layer by layer thus avoiding unnecessarily large incisions and minimizing scar size. The technique results in the highest reliable published cure rates for skin cancers while optimizing functional and cosmetic outcomes.
This is an outpatient procedure performed under local anesthesia very similar to the initial biopsy. In the majority of cases, patient undergo reconstruction on the same day of the surgery by the same surgeon.
Mohs micrographic surgeons are specially trained in surgically removing the tumor, microscopically examining the tumor, and performing the reconstructive surgery. Our surgeons are board-certified dermatologists who completed ACGME-accredited fellowships in Mohs micrographic surgery and are members of the American Academy of Dermatology and American College of Mohs Surgery.
How Is Moh’s Surgery Performed?
Moh’s surgery can be broken down into a multi-step process. The first step is your initial examination and diagnosis. Once a definitive diagnosis is made, Moh’s surgery will be scheduled.
On your surgical date, the area of skin cancer will be marked. It will be anesthetized, and all areas of skin cancer and its surrounding margins will be excised. The excised tissue will be marked and sent for frozen section. The specimen will be checked for cancer cells. This process will be repeated until the specimen returns clear of any cancerous cells. If clear, your surgeon will close the excision site. Depending on the depth of the excision, reconstructive surgery may be performed at the same time.
What Types of Skin Cancer Can Moh’s Surgery Treat?
Moh’s surgery is usually performed to remove basal cell carcinoma. However, it may also be performed to remove squamous cell carcinoma and melanoma.
Is Moh’s Surgery Painful?
In most cases, no. You will receive a local anesthetic prior to excision. After the procedure, you experience some discomfort, however, your surgeon may prescribe pain medication to keep you comfortable. Otherwise, they may recommend over-the-counter pain relievers.
Can Moh’s Surgery Be Performed on Other Parts of the Body?
Yes, Moh’s surgery can be performed on other parts of the body, but it is mostly performed on the face, hands, and back. In these areas, there is usually more tissue available to help close the wound successfully with a skin graft.
What Are The Benefits Of Mohs Surgery?
This procedure allows dermatologists, trained in MOHS surgery, to see beyond the visible disease and to precisely identify and remove the entire tumor, leaving healthy tissue unharmed.
This procedure is most often used in treating two of the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma. At Georgia Dermatology Partners, we are proud to offer MOHS surgery to patients in Snellville, Loganville, and Braselton, GA.
“Georgia Dermatology Partners are the best! I’ve had some minor skin cancer issues that they removed. Everything went very smooth. I come back once a year for a skin checkup. The staff and doctors are very friendly and provide outstanding treatment. I’m very satisfied. You owe it to yourself to check them out!”
Who Is A Candidate For Mohs Surgery?
Mohs surgery is far and away the best option for treating most basal cell carcinomas and squamous cell carcinomas. This is especially true if your lesions are in cosmetically and functionally important areas around your eyes, nose, lips, ears, scalp, fingers, toes, or genitals. Mohs is also recommended for basal cell and squamous cell cancers that are large, aggressive or growing rapidly, that have indistinct edges, or have recurred after previous treatment.
How Is Mohs Surgery Performed
The roots of a skin cancer may extend beyond the visible portion of the tumor.
If these roots are not removed, the cancer will recur.
The visible portion of the tumor is surgically removed.
A layer of skin is then removed and divided into sections. The Mohs surgeon then color codes each section with dyes and makes reference marks in the skin to show the source of these sections. A map of the surgical site is then drawn.
The under surface and edges of each section are then microscopically examined for evidence of remaining cancer.
If cancer cells are found under the microscope, the surgeon marks their location on the ‘map’ and then returns to the patient to remove another layer of skin, but only precisely where the cancer cells remain.
The removal process stops when there is no longer any evidence of cancer remaining in the surgical site. Because Mohs surgery removes only tissue containing cancer, it ensures that the healthy tissue is kept intact.
How Long Does Mohs Surgery Take?
There is no “set” timeframe for Mohs procedures at Georgia Dermatology Partners: it simply depends upon the number of rounds necessary to find a clear border. If more than one or two rounds are necessary, the entire process can take up to several hours. It’s worth it, though, considering Mohs takes the least amount of tissue, but has the highest cure rate of any treatment method.
Due to the testing phases, Mohs surgery involves a lot of downtime for the patient, as he or she waits for the lab results to see if the outer ring was clean. During these times, the patient can read, watch videos, or even leave the room.
What Are The Risks Involved With Mohs Surgery?
Mohs surgery is surgery, so it carries the same risks of excessive bleeding, possible infection, and continuing pain or tenderness around the incision site. There are other rare complications:
- Temporary or permanent numbness surrounding the surgical areas, if small nerve endings are cut
- Temporary or permanent weakness of the surgical area if the tumor was large and a muscle nerve was severed
- Itching or shooting pain in the treatment area
- Development of a keloid scar (enlarged beyond the actual incision borders)
The risks above are also the same with traditional excisional surgery. At Georgia Dermatology Partners, we like Mohs methods because they involve a much more systematic removal of only necessary tissue. That itself is lower risk than traditional skin cancer surgery.
Very efficient office, took care of my MOHS surgery very quickly and relatively painlessly. Highly recommend this very professional office – K.H.
How Successful Is MOHS Surgery?
The cure rate with MOHS micrographic surgery is the highest of all treatments of skin cancer (up to 99 percent) even if other forms of treatment have failed. This procedure, the most exact and precise method of tumor removal, minimizes the chance of re-growth and lessens the potential for scarring and disfigurement.
What Will Recovery Be Like After Mohs Surgery?
Your recovery after Mohs surgery at Georgia Dermatology Partners will be the same as for traditional skin cancer removal. There will be some bruising and crusting of the wound for the first two to three weeks. The basic recovery of your wound will take from several days to several weeks, depending on the size, complexity of the incision closure, and the location.
This is just the surface recovery, as complete healing of the surgical scar takes from 12-18 months.
During the early months after surgery, your wound will likely itch at times. It may also be numb but feeling should return with time. Your scar will have a reddish appearance and the skin may actually contract and tighten. These are both temporary changes. Most scars initially are red and raised but flatten and fade in six months to a year. You can gently massage the area beginning about one month after your surgery; this speeds the healing process.
Once healed, if you’re concerned about your scar, we have various cosmetic procedures that can lessen its appearance.
Does Mohs Surgery Leave A Scar?
Whenever an incision is made in human skin a scar will form. That’s just the way our skin heals. The nice aspect of Mohs surgery is that it enables our Georgia Dermatology Mohs surgeon, Dr. Wright, to preserve as much healthy tissue as possible, while still being able to be sure that he has removed all of the cancer cells. This isn’t the case with traditional excisional methods, as it is usually necessary to take a far larger border around the lesion just to be sure it’s hopefully wide enough to get all the cancer. Dr. Wright has extensive training and experience with Mohs micrographic surgery ensuring you’ll have the smallest scar possible. He is also excellent with subsequent options for minimizing your scarring, such as the possible use of a skin flap.
Can I Drive Myself Home After My Surgery?
These procedures are performed using local anesthetic to numb the surgical area. This means you could theoretically drive in most cases. Obviously, that would not be the case if you’ve received a sedative or your Mohs surgery was near the eye, hands, or feet. Still, most people have someone come with them during their surgery. This gives them someone to interact with during the breaks when we are testing the tissue taken in the previous round. Plus, that person can then drive you home.