Mohs Surgery

Mohs Surgery for Skin Cancer

What Is Mohs Surgery?

Mohs surgery is a highly effective and precise surgical technique used to treat skin cancer. Named after Dr. Frederic Mohs, who developed the procedure, Mohs surgery involves the systematic removal and microscopic examination of cancerous tissue until only cancer-free tissue remains. This method ensures that all cancer cells are eradicated while preserving as much healthy tissue as possible, making it particularly valuable for treating skin cancers in cosmetically sensitive areas like the face, ears, and hands.

What Are Squamous and Basal Cell Carcinoma?

Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the two most common types of skin cancer. BCC originates in the basal cells, which are found in the lower part of the epidermis. It often appears as a translucent bump on the skin, though it can take other forms, such as flat, scaly patches. BCC is typically slow-growing and rarely spreads to other parts of the body. SCC, on the other hand, arises from the squamous cells, which make up most of the skin's upper layers. SCC can appear as a firm red nodule or a flat lesion with a scaly, crusted surface. It tends to grow more rapidly than BCC and has a higher risk of spreading, making early detection and treatment crucial.

The Mohs Surgery Procedure

Mohs surgery is a highly effective and precise surgical technique used to treat skin cancer, particularly BCC and SCC. The procedure involves the systematic removal and microscopic examination of cancerous tissue until only cancer-free tissue remains. This method ensures that all cancer cells are eradicated while preserving as much healthy tissue as possible. The surgery begins with the surgeon removing a thin layer of visible cancerous tissue.

‍

Mohs surgery is typically performed on an outpatient basis under local anesthesia. The procedure begins with the surgeon removing a thin layer of visible cancerous tissue. This layer is then divided into sections and carefully mapped. Each section is examined under a microscope to check for cancer cells. If cancer cells are found at the margins, the process is repeated—removing another thin layer from the specific area where cancer cells were detected. This process continues until no cancer cells are seen, ensuring complete cancer removal. The precision of Mohs surgery minimizes the need for additional treatments and reduces the likelihood of cancer recurrence.

Mohs Day with Reconstruction

After the cancerous tissue has been completely removed, the reconstruction phase begins. The type of repair or reconstruction depends on the size and location of the wound, as well as the patient's ability to tolerate additional procedures. Reconstruction options may include linear repair, flap surgery, grafting, or allowing the wound to heal by secondary intention (granulation). Some reconstructions can be performed on the same day as the Mohs surgery, while others may be scheduled for a subsequent day. The goal of reconstruction is to restore both function and cosmetic appearance, ensuring the best possible outcome for the patient.

Length of the Procedure

The duration of Mohs surgery varies depending on the depth and extent of the skin cancer. Simple cases where the cancer is shallow and confined to a small area may be completed within a few hours. However, more complex cases with deeper or more extensive cancer can take longer, sometimes requiring multiple stages of tissue removal and examination. Each stage of the procedure, including tissue removal, mapping, and microscopic examination, takes about 30-60 minutes. Patients should be prepared for a full day at the clinic, as the precise nature of Mohs surgery prioritizes thoroughness over speed to ensure complete cancer removal.

Benefits of Mohs Surgery

Mohs surgery offers several key benefits:

• High Cure Rate: Mohs surgery has the highest cure rate of all skin cancer treatments, with success rates up to 99% for primary basal cell carcinoma and squamous cell carcinoma.
• Tissue Preservation: By removing only the cancerous tissue and sparing as much healthy tissue as possible, Mohs surgery results in smaller scars and better cosmetic outcomes.
• Outpatient Convenience: The procedure is performed on an outpatient basis, typically allowing patients to return home the same day.
• Real-Time Results: The immediate microscopic examination of tissue samples ensures that all cancer cells are removed during the procedure, reducing the need for further surgeries.

Aftercare and Recovery

After the surgery, patients will receive detailed instructions for wound care to promote healing and minimize scarring. Most patients experience minimal discomfort, which can be managed with over-the-counter pain relievers. Follow-up visits are essential to monitor the healing process and ensure that the cancer does not recur. Patients are also advised to practice sun protection and perform regular skin self-examinations to detect any new or recurrent skin cancers early.

Insurance Coverage

Mohs surgery is generally covered by insurance because it is a medically necessary procedure for the treatment of skin cancer. Patients should check with their insurance providers to understand their coverage specifics and any potential out-of-pocket costs. The team at True Dermatology can assist with insurance inquiries and provide necessary documentation to facilitate coverage.