Mohs Surgery for Skin Cancer: What to Know

Mohs surgery, also called Mohs micrographic surgery, is the most effective treatment for many types of skin cancers. It has a cure rate of up to 99%. Please continue reading to learn what happens when you have Mohs surgery performed.

What is Mohs micrographic surgery?

Mohs surgery is a single-visit procedure performed in an outpatient setting by specially trained Mohs surgeons to treat skin cancer (i.e. plastic surgeons, dermatologist). It offers precise results in removing common types of skin cancer, such as basal cell carcinoma and squamous cell carcinoma. Most patients do not need more surgery after Mohs, and it is typically curative for skin cancer.

What do I need to know before Mohs surgery?

Preparation

Your doctor may ask you to stop taking certain medications, such as blood thinners, before your Mohs surgery. They may also prescribe preoperative antibiotics.

Anesthesia

A Mohs procedure is performed using local anesthesia. You remain awake throughout (unlike procedures performed with general anesthesia where you are asleep in an operating room). The local anesthetic numbs the area and prevents pain as the surgeon removes thin layers of tissue from the affected area.

Procedure

During a Mohs procedure, a Mohs surgeon removes a thin layer of tissue at the site of the skin cancer. The goal is to remove all the cancerous tissue and leave behind as much normal skin as possible to minimize the size of the scar. This part of Mohs surgery, where the surgeon cuts the layer of skin, is quick, taking only a few minutes.

The tissue sample is then sent to a pathologist while you wait in the doctor’s office. The pathologist examines the tissue under a microscope to see if any cancerous cells remain at the margins of healthy tissue. This part of the Mohs surgery can take up to an hour. The entire procedure can be lengthy, so you should bring something like a book or tablet to keep yourself entertained. You can eat while you wait and use the restroom in the waiting room, but you cannot leave the doctor’s office.

If cancer cells remain on microscopic examination, the surgeon removes another layer of skin. This process continues and is repeated as many times as necessary to remove more skin until no more cancer cells remain. Once it is confirmed there are no more cancer cells in the skin removed, the surgeon closes the wound, leaving behind as much healthy tissue as possible.

Advantages

A key advantage of Mohs micrographic surgery is that it allows precise location and removal of cancer cells. In addition, you don’t have to wait for the results. You know right away that the skin cancer has been removed entirely, and no more cancer cells remain.

What should I expect after Mohs surgery?

A Mohs procedure allows as much healthy skin to be left behind as possible. The goal is to ensure you are skin cancer-free and have the smallest wound and scar possible.

However, many patients are surprised by the large size of the wound at the surgical site after a Mohs surgery. This is because common skin cancers like basal and squamous cell carcinomas often extend beyond the visible portion. There are several ways in which your surgeon can help the surgical area heal, including:

Natural healing by granulation and reconstructive surgery on the scar, if needed in the future, by a plastic or oculoplastic surgeon.
Closure of the wound with stitches.
Use of a skin flap from nearby healthy tissue (this method offers an excellent cosmetic match with surrounding skin).
Use of a skin graft (removal of a small piece of skin from the thigh or near the ear or collarbone for wound coverage). Both the donor and graft sites are stitched to promote healing.

What can you not do after Mohs surgery?

You should avoid vigorous physical activity and heavy lifting until your wound heals after Mohs surgery. These activities can increase the risk of bleeding and opening up your stitches.

How long does it take to recover from Mohs surgery?

Most patients recover within 4-6 weeks of Mohs surgery. The time it takes for the wound to heal completely depends on the size of the skin cancer that was removed. You should follow your surgeon’s wound care instructions to speed up healing and prevent complications.

Can you get Mohs surgery for melanoma?

According to the Skin Cancer Foundation, Mohs surgery is the gold standard for treating many skin cancers, such as basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). However, it is less commonly used to treat melanoma, although some Mohs surgeons have done so successfully.

Mohs surgery can be performed in delicate areas such as the face, scalp, and genitals. It can also be done to remove skin cancers that are large, aggressive, have unclear edges, are growing rapidly, or have come back after previous treatment.

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