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Everything You Need to Know About Mohs Surgery

Everything You Need to Know About Mohs Surgery

Mohs surgery is a precise method for removing a skin cancer tumor while preserving as much healthy skin as possible. It is used most often to remove melanoma. 

This procedure was named after Frederic E. Mohs, the surgeon who developed the microscopically controlled surgery. Mohs allows for the maximum removal of cancerous tissue with a minimum removal of healthy cells. It leaves the smallest scar possible. 

What’s the idea behind Mohs surgery?

Most skin cancers consist of visible tumors, but sometimes they grow “fingers” of cancer extending into surrounding healthy skin that are so small they can only be found with a microscope. Any cancer cells left behind can cause the tumor to reappear.

The conventional approach to operating on skin cancers is to cut out the visible tumor. Since the tumor may or may not really be cancerous, your surgeon will also remove a margin of healthy tissue. Then, in 99% of cases, the tumor will be sent off to a lab for analysis. If the pathology report comes back a few days later and your tumor turns out to be an aggressive form of cancer, like melanoma, you will be asked to come back for another surgery.

Mohs surgery takes a different approach.

In 100% of Mohs surgeries, you will know that the skin cancer being treated is entirely removed before you leave the office. 

Mohs surgery is the treatment of choice for most skin cancers on the neck and face and the more aggressive skin cancers. Mohs surgery has a 94% success rate for tumors that have been previously treated. It has a 99% success rate for tumors that have not been treated before.

What is it like to have Mohs surgery?

Mohs surgery is done in a single visit. It may be a little uncomfortable, and it can run a little long, but your dermatologist will control pain with a local anesthetic. 

Here’s what you can expect during your Mohs surgery:

Exam and prep

If you are scheduled for Mohs surgery, it has already been confirmed that you have one or more skin cancers that need to be removed. If you are having Mohs surgery on your face, you may stay in your street clothes the whole time you are in the office. If you are having surgery on some other part of your body, you may need to put on a hospital gown.

You will be put into the position that gives the physician the best access to the tumor. 

Top layer removal

Next, the doctor will inject a local anesthetic to control any pain. The top layer of cells will be shaved off with a scalpel and immediately taken to the onsite lab. This procedure takes just a few seconds. But you will have to wait a while for the doctor and a technologist to perform the next step.

The first lab test

Your dermatologist will continue to cut the tissue in sections. Those sections are then stained for pathology review, and the physician will draw a map of the surgical site and then examine the tissue in the lab.

The lab work is done with the help of a highly trained technologist who will flash-freeze the divided tissues. This makes it possible to cut them into very thin slices. The technologist places the skin tissue on microscope slides, stains them, and covers them with glass slips. Then Dr. Storey will review each layer of tissue under a microscope.

Pathology of skin samples is meticulous work. It takes time. Nearly all the time you spend at your Mohs surgery will be waiting for lab results.

Next, your dermatologist does a microscopic examination

The physician will look at all the edges and undersides of all the tissue on the slides. If there are any cancerous cells, the surgeon marks their location on the map. At this point, the doctor will let you know if you need more tissue removed.

The physician will repeat this procedure as often as necessary until all of the cancer cells are eliminated. Mohs surgery can take several hours. You can know the extra time is worth it because this procedure finds the margins of cancer precisely so that you can focus on a cancer-free recovery.

Closing the Wound

When all of the skin cancer has been removed, you will be left with a wound that needs to be repaired. Your doctor will discuss the various options to leave the smallest scar. The best Mohs surgeons have additional training in cosmetic reconstruction of wounds and do that work in their office before you go. See photos of actual patients who had Mohs surgery at Valley Skin Institute.

Follow-up care to monitor your healing will be necessary.

When is Mohs surgery recommended?

Mohs surgery is especially appropriate for cancers that have a high chance of coming back. These include basal cell carcinoma, squamous cell carcinoma, and some kinds of melanoma.

Mohs surgery is the gold standard for treating basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) around the eyes and on the eyelids, on the face, ears, lips, scalp, or the fingers, or toes. It’s the right treatment for many BCCs and SCCs that are growing fast and have irregular edges.

How to find the best Mohs surgeon  

Many dermatologists perform Mohs surgery. However, some dermatologists have additional surgical training and more experience. A dermatologist who has completed a two-year Mohs Fellowship Program approved by the American College of Mohs Surgery has the best training available in the world.

Asking questions is essential when deciding on who will perform your surgery. Here are a few to consider asking:

  • How much additional training has the dermatologist received in Mohs Surgery? 
  • How long has the doctor been performing Mohs surgery?
  • How many Mohs procedures does the doctor perform annually?

The answers to these questions will help guide your decision-making.

Valley Skin Institute is here to help. Dr. Leslie Storey began doing Mohs surgery in 2007 and performs more than 1500 Mohs surgeries every year. 

You can start a conversation about skin cancer care online or call us at (559) 472-SKIN. That’s (559) 472-7546. 

 

Dr. Leslie Storey | Valley Skin Institute

Dr. Leslie Storey is a board-certified physician specializing in medical and surgical dermatology. Her mission is to find and remove skin cancer, which she does more than 2,000 times a year. An expert in Mohs Surgery, Dr. Storey’s patients often comment that they are amazed at how minimal their scar is after they have healed from surgery. If you notice anything suspicious on your skin, request an appointment with Dr. Storey to have it checked out.

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