Mohs Micrographic Surgery at Skin And Cancer Institute
Mohs micrographic surgery is a cutting edge skin cancer treatment performed by only the most highly skilled surgeons. The procedure starts with the removal of a small area of skin cancer, which is immediately tested under a microscope onsite to determine the location of the cancer cells in the sample. Patients remain in the operating room during testing. Once analysis pinpoints the direction of the cancer’s growth, another small layer of skin is removed and examined. This process continues layer by layer until all skin cancer cells have been removed. Mohs micrographic surgery is unique compared to other skin cancer surgeries, because only areas containing actual skin cancer are removed, leaving as much healthy skin as possible in the margins surrounding the excision.
Mohs surgeons examine the removed tissue for evidence of extended cancer roots. Once the visible tumor is removed, Mohs surgeons trace the paths of the tumor using a microscope and a map of the surgical site. Once the obvious tumor is removed, Mohs surgeons remove an additional, thin layer of tissue from the tumor site. They create a “map” or drawing of the removed tissue to be used as a guide to the precise location of any remaining cancer cells. They microscopically examine the removed tissue thoroughly to check for evidence of remaining cancer cells.
If any of the sections contain cancer cells, Mohs surgeons return to the specific area of the tumor site, and remove another thin layer of tissue only from the specific area within each section where cancer cells were detected. They then microscopically examine the newly removed tissue for additional cancer cells. If analysis continues to show evidence of cancer cells, the process is continued layer-by-layer until the cancer is completely gone. This process ensures that all the diseased tissue and only the diseased tissue is removed, minimizing the cosmetic impact. Mohs surgeons are dermatologists who have extensive knowledge of the skin and its healing properties, as well as training in reconstructive surgery. They understand wound management, which helps produce the best cosmetic result. Most Mohs surgeons will perform the reconstructive surgery necessary to repair the wound at the time of the surgery.
While other cancer treatments require multiple costly procedures, most Mohs patients only need one affordable Mohs surgery to completely remove all cancerous cells.
Mohs micrographic surgery takes only one day to remove all skin cancer cells. Other treatment plans require lengthy operating and testing periods before patients are cancer free.
After Mohs micrographic surgery, 99% of first time skin cancer patients and 94% of recurrent cancer patients are cancer free, according to the American College of Mohs Surgery.
Unlike other skin cancer surgeries, Mohs micrographic surgery removes only areas containing actual skin cancer, leaving as much healthy skin as possible in the margins surrounding the excision.
Most patients diagnosed with skin cancer are good candidates for Mohs micrographic surgery. There are a few factors that may affect your ability to have surgery, so speak with a Mohs specialist to find out more.
Since Mohs surgery works layer by layer to remove cancer cells as they are found, each procedure is individualized. You may be in surgery anywhere from one hour to an entire day, depending on how many skin cancer layers must be removed.
Prior to surgery, you may be given oral pain medication and possibly a prescription to help you relax. During the procedure, you will be given injectable anesthetic.
At Skin And Cancer Institute, all wounds from Mohs procedures are dressed with EpiFix, the latest technology in wound care. EpiFix is a wound dressing that uses amniotic membrane and other proteins from live human cells to create a barrier over wounds. This highly specialized patch accelerates healing, minimizes inflammation, and reduces scar tissue.
Skin And Cancer Institute pairs EpiFix with Hibiclens, another specialized tool for advanced wound care. Hibiclens minimizes and even eliminates the chances of postoperative infections. It works by killing germs on contact and then bonding to the skin for continued antimicrobial defense.
Once the procedure is complete, your surgical team will provide detailed after care instructions to help you heal as quickly as possible. To avoid infection and minimize scarring, be sure to carefully follow every step of these instructions.
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 removed and divided into sections. The ACMS surgeon then color codes each of these sections with dyes and makes reference marks on the skin to show the source of these sections. A map of the surgical site is then drawn.
The undersurface and edges of each section are microscopically examined for evidence of remaining cancer.
If cancer cells are found under the microscope, the ACMS surgeon marks their location onto the “map” and returns to the patient to remove another layer of skin – but only from 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 maximum amount of healthy tissue is kept intact.
Be sure to get plenty of rest the first few days after Mohs micrographic surgery. Most patients are able to return to work the next day. You must incorporate proper wound care routines into your daily schedule, even if you are at work or enjoying a day out. This may require cleaning your wound with soap or hydrogen peroxide two to three times a day and applying a prescription cream or gel to the area. Avoid heavy lifting, straining, and strenuous exercise for two weeks after surgery, though it may be advised for a longer period depending on your surgical wound. Most patients report minimal discomfort after surgery, but your surgeon may give you a prescription for pain medication if it is needed.
Depending on how much skin was removed during surgery, you may have a bulky pressure dressing on your wound. Though you may not go swimming while your wound is healing, you may begin to take quick showers 24 hours after surgery. Mild swelling is not uncommon the first day or two, so your surgeon may suggest applying a cold compress in 15 minutes sessions a few times a day. Sleeping propped on a pillow or in a reclining chair may decrease swelling, and you may find that it’s a more comfortable way to sleep while you are recovering.
If your surgical site required stitches, they will be removed at the dermatologist’s office anywhere from 4-14 days after surgery.
If Mohs micrographic surgery removed a large area of skin, you may choose to have a reconstructive procedure once your wound is healed. This can be as soon as a few months to a year after surgery. Not all Mohs patients choose to undergo reconstruction, and in many cases, it’s not even necessary. At Skin And Cancer Institute, our Mohs surgeons use specialized suture techniques to reduce scarring and minimize the need for reconstructive procedures.
A: Your physician will give you aftercare instructions on how to care for the area where Mohs was performed. Take precautions to help reduce the
likelihood that additional skin cancers will develop and/or ensure early detection:
If any of these skin changes occur, see your dermatologist
For more information about Mohs micrographic surgery, EpiFix, and Hibiclens, check out these helpful links: