Mohs Microscopically Controlled Surgery

What is Mohs Surgery?
What are the risks?
What should I do to prepare before surgery?
What should I do on the day of surgery?
What should I do once the surgery has been done?


What is Mohs Surgery?

Mohs surgery is a procedure which removes skin cancer. It has the highest cure rates, and preserves the greatest amount of normal skin.
The steps involved are the following:

  1. A local anesthetic is used to numb the area around the tumor.
  2. The visible tumor is removed.
  3. A slice of tissue is taken from the site where the visible tumor was removed. This tissue is used to determine if any cancer cells are remaining or if they were all taken out with the procedure. The thin slice of tissue is divided into sections, so that a "map" of the area is known.
  4. The sections of the tissue slice are looked at under a microscope. If any cancer cells are found, the remaining cancer is removed. Once more tissue is surgically removed, steps 3 and 4 are repeated until no further cancer is found.


What are the risks?

As with any surgery,

  1. Allergic reaction to the local anesthetic.
  2. Bleeding during or after the procedure.
  3. Infection of the wound site.
  4. Skin numbness at or around the cancer site. This is usually a temporary result, lasting 6 to 12 months.
  5. Nerve damage can occur if the cancer invasion is deep. Nerves that control muscles can be injured, and the damage can last 6 to 12 months, or it could be permanent.
  6. Although it might not show up for months or years, the cancer could come back. Regular follow-up is essential. Patient who have had skin cancer are not only at risk for the cancer recurring, but they are also at risk for other cancers.
  7. Scarring will occur as it is part of the healing process. Because people scar differently from one another, some may require a scar revision.

What should I do to prepare before surgery?

Before surgery,

  1. Medications you should or should not take: Do not take aspirin or products with aspirin in them for one week before surgery. However, YOU MUST GET THE DOCTOR WHO PUT YOU ON YOUR MEDICINE TO OKAY STOPPING ITS USE! Let us know if you are taking any blood thinning medicines (for example, Coumadin, Ticlid, Plavix) or medicines for arthritis. These products may cause increased bleeding. Tylenol is safe to take before and after your surgery.
  2. Do not drink any alcohol for two days before or after your surgery. Alcohol may increase your risk of bleeding.
  3. Do not smoke for two weeks before or after surgery. Smoking may interfere with healing.
  4. Make sure you have told the doctor of any special medical problems you have, such as artificial heart valves, rheumatic heart valve disease, or artificial joints. Any of these may require antibiotics. Are you a hepatitis or HIV carrier? Do you faint easily?

What should I do on the day of surgery?

What should I do once the surgery has been done?

When the cancer has been removed, Dr. Hendrix will discuss wound management with you. Each wound is different and there will often be several options open to you.

  1. The wound can be allowed to heal on it's own.This process normally takes a month or two. You will have to clean the wound every day and put on a new bandage.
  2. The wound can be stitched together. These stitches will usually be removed in 1-2 weeks. The stitched area normally requires cleaning and putting on a new bandage every day.
  3. A skin "flap" is another option. This involves moving skin next to the wound over it. Stitches will be used and removed in 5-10 days in most cases.
  4. A skin "graft" can be used to cover the wound. Skin is borrowed from another location on your body and sewn into place. There are then two wounds to care for; one from the borrowed site and one at the site where the graft was sewn in. The sutures are removed from both sites in about one week.
  5. After any type of repair (such as a skin flap or graft), a second procedure may be needed to improve the scar that is left. This may take place in several weeks, up to a year.
  6. There are times when a repair is postponed for one day or even up to a week.
  7. As the wound heals you may feel skin tightening, itching of the scar or small sharp pains in the scar. These feelings are normal and will lessen as time passes.
    The new skin that forms has many new blood vessels and will look redder than the skin around it. The redness will fade in time. Massaging the scar with a moisturizing cream will often help flatten, soften, and decrease itching of the scar.
    It is important to protect this new skin, as well as the rest of your skin, from the sun. Apply at least a number 15 sunscreen before going out into the sun and apply it several times during the day. However, wait until the wound has healed before applying sunscreen to that area.

RESTRICTIONS AFTER SURGERY

  1. If you exercise or swim on a regular basis, please ask when you may start up again.
  2. Often the patient may return to work a day or two after the surgery but this is different from case to case. Please ask when you can go back to work.
  3. Limit your sun exposure.
    • Use a sunscreen of SPF 15 or greater.
    • Schedule your outdoor activities to avoid mid-day (10 am-3 pm).
    • Wear a broad brimmed hat.
  4. It is important that you have follow-up visits at least every 6-12 months after surgery or by a schedule that is set up for you. Follow-up schedules may vary among patients because of the type of cancer or precancer that each patient may have.