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Education Library: Mohs Micrographic Surgery for Skin Cancer

Introduction

Mohs micrographic surgery is a specialized surgical treatment for the removal of skin cancer. Mohs surgery is highly effective. It offers the highest potential for recovery for all skin cancer treatments. Mohs surgery has a five-year cure rate of 99% for certain types of cancer, according to the American Society for Mohs Surgery.

Mohs surgery is most frequently used to treat select basal cell carcinomas and squamous cell carcinomas. It may also be used for less common skin cancers, such as melanoma. Mohs surgery is used for large areas of cancer. Some skin cancers may appear small on the surface of the skin, when in fact they have roots and extensions beneath the skin that may be quite extensive. Mohs surgery is especially suited for tracking and removing cancerous roots.

Mohs surgery is used for recurrent skin cancer, cancer that was previously treated and returned. Mohs surgery is used for rapid growing cancer or cancer with poorly defined edges. It is useful for cancers that are in scar tissue. Because Mohs surgery spares healthy skin, it is recommended for cosmetic reasons for skin cancers on select areas, including the eyelids, nose, ears, hairline, and lips.

Mohs surgery for skin cancer is unique in several ways. This state-of-the-art treatment technique removes the skin cancer and only a very small amount of surrounding healthy tissue. It saves as much healthy tissue as possible. The skin cancer is carefully mapped to create a precise guide for the surgeon. Mohs surgery removes skin cancer in very thin layers. The Mohs surgeon immediately examines the specimens. This ensures that all of the cancer’s roots and extensions are removed. The process is methodically repeated until no cancer cells are noted on the specimen.

Treatment

Mohs surgery is an outpatient procedure that can be performed in your doctor’s office. You are awake for the entire procedure. The area to be treated on your skin is first numbed with a local anesthetic and cleansed.

Your surgeon will remove the visible skin cancer and only a thin layer of healthy tissue. Your doctor will cut the specimen into four sections and map it. A technician freezes the tissue and removes very thin slices for examination. This is the most time consuming part of the entire procedure. It often requires at least one hour of preparation time.

Your surgeon will carefully examine the specimen. All remaining cancer and microscopic roots are pinpointed on the map. Your surgeon will use the map to remove additional tissue only where cancer is present. This process is methodically repeated until no cancer remains.

Most Mohs surgeries can be completed in three stages or less. The treatment process may require up to four hours to complete. You should plan on spending a large block of time or a whole day for your procedure because it is impossible to predict the extent of the skin cancer’s roots before surgery.

When the Mohs microsurgical process is complete, the wound is closed. Wound closure depends on the location and size of the affected area. Small wounds may simply be closed with stitches. If there is little tissue left to cover and close the wound, a skin flap may be used. A skin flap involves surgically rotating or moving nearby skin to secure it over the wound. In some cases, a skin graft may be necessary. A skin graft entails removing a section of skin from another area on the body and securing it over the wound.

Mohs microsurgery leaves the smallest scar possible. Complications from scars may be treated with several procedures, including injected medications and laser resurfacing. Skin grafts and flaps may also be "touched up" to improve their appearance.

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