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MOHS Procedure


"Mohs is a very precise, highly detailed technique whereby small layers of skin are sequentially removed and immediately examined under the microscope until the samples indicate that the skin cancer is completely removed"

Patient Information Brochure PDF

 Overview Information PDF

Pre-Treatment Information PDF

Post Operative Wound Care PDF

Learn more about MOHS Procedure

Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. Mohs surgery is also known as Mohs micrographic surgery.

This unique form of surgery was developed over 50 years ago by Dr. Frederick Mohs, a professor of surgery at the University of Wisconsin. Since that time, the technique has been refined and advanced so that today it is offered by certified Dermatological Surgeons throughout the country. Its wide acceptance stems from the fact that for certain kinds of skin cancer, it offers a cure rate of approximately 98%.

Mohs surgery is performed by a team specially trained in this technique. The team includes a Mohs certified physician, surgical assistants, and a technician who is responsible for preparing the tissue for microscopic examination. You will meet the entire team at the time of your consultation and/or surgery.

The surgery is done on an outpatient basis, except in rare circumstances. Local anesthesia is used to numb all feeling in the area. A thin layer of skin at the tumor site is then removed. This layer is marked, frozen and stained, so that it can be examined under a microscope. If any cancerous tissue is found at the edges of the first layer of skin, the doctor will repeat the process of removing another layer and preparing it for microscopic examination. These steps will be repeated until the entire tumor is removed. Depending on the extent of the tumor, there may be several stages (repetitions or layers) of surgery.

Each stage takes approximately 45 minutes to an hour. Since we cannot determine in advance how many stages you will require, Please keep your schedule clear that day as it can take up to 8 hours to completely clear a site of cancerous tissue; however, it rarely takes more than this. The majority of patients are released within 3 to 4 hours.

The major advantage of this technique is that we only have to remove the cancerous tissue, therefore, sacrificing little of the surrounding healthy skin. This is particularly important if the cancer is close to vital structures such as the nose, eyes, or ears. Of course any surgical procedure may leave a scar, but by preserving the maximum amount of healthy skin, we hope to allow the best cosmetic result. In addition, by viewing the tissue under the microscope at the time of surgery, we can be more confident that the entire skin cancer has been removed.

Since we cannot know ahead of time the extent of the tumor, it is difficult to discuss the repair of the skin until the surgery is completed. There are several ways of repairing the surgical site; 1) to let it heal by itself, 2) to suture the wound together, or 3) using a skin graft or flap, which involves moving healthy skin from elsewhere to cover the defect. 4) Sending out to a plastic surgeon. When the tumor has been completely removed, and we know the size and shape of the defect, we will discuss with you the best options for repair.

As with any procedure, there may be complications. Complications may include but are not limited to; scarring, infection, nerve damage, hematoma, allergic reactions, flap and graft necrosis, and seroma. Some bleeding during surgery is expected, although it is uncommon for this to occur during the post-operative period. Infection rarely occurs and is controlled by oral antibiotic. ***20 minutes on, 20 minutes off of cold packs that day and possibly day after will minimize bruising and discomfort***

Most scars are numb because sensory nerves have been cut. Sometimes adjacent skin may also be numb for up to 6 months or longer. Rarely the tumor may be located around nerves that control movement so that nerve damage may result from removal of the tumor. Allergic reaction can occur due to the local anesthesia, or bandaging materials. Postoperative discomfort is typically minimal, and most people can return to work the following day.

You can expect some degree of scarring as a result of this procedure; however, it usually matures over several months and becomes acceptable cosmetically. Some scars will be pink and bumpy for three to nine months. Scars that do not mature well can often be revised. Most revisions are done 12 months after the original surgery.

It is important to note that some patients can have their tumors recur even after MOHS surgery has been carefully performed.

 

MOHS SURGERY PRE-OP INSTRUCTIONS


These instructions are to be followed before and after your surgery. Please call us if you have any questions or need further clarification.
A. Aspirin Related Drugs (Stop taking 10-14 Days prior to your surgery)
For a two-week period prior to and after the scheduled date of your surgery, please do not take any medication that contains aspirin or aspirin-related products, such as ibuprofen (Motrin, Advil) as an ingredient. Aspirin has an effect on your blood's ability to clot and could increase your tendency to bleed at the time of surgery and during the post-operative period.
Notify the nurse if you are on blood thinners. We may have you check with your physician about briefly stopping them.
If you need minor pain medication, please take acetaminophen (Tylenol) or another non-aspirin medication.
The following is a list of the more common medications and substances that can increase your tendency to bleed. These should be avoided for two weeks prior to and after your surgery.

B. Antibiotics (Start taking the day before your surgery)
Please take the prescribed antibiotic twice a day (one in the morning and one in the afternoon), the day before surgery, the day of surgery, and the day after surgery. The prescription provided to you in advance of your surgery from our office. You will take a total of 6 pills.

C. Wound Care (Have these items on hand prior to your surgery for your post-op care)
1. Non-adherent pads
2. Cotton gauze (100% Cotton)
3. Paper tape (Hypoallergenic)
4. Band-Aids
5. Antibiotic ointment (Bacitracin or Polysporin)

Refer to your specific wound care instructions for more information post-surgery.

D. Surgery Day
1. Eat breakfast before you arrive.
2. Take your regularly prescribed non-aspirin medications. Please bring a list of your medications with you on your surgery day. Advise the nurse or doctor of any over-the-counter medications that you are taking.
3. We recommend a shower the morning before surgery and freshly laundered clothes to help reduce the risk of you getting an infection. If your surgery involves your trunk, wear a shirt or blouse that buttons up the front for ease of removal.
4. Do not apply makeup, cream, lotion, aftershave, etc. to the affected area.
5. Bring some reading material or something to keep you occupied as you may be in our office for a period of 4 hours or more.
6. We have a special waiting room with a television, refrigerator, and some snacks. However, you may wish to bring a lunch if you need more substantial food while you are here.
7. Please call our office if you get sick within 24 hours of your surgery.
8. Please notify us if you are allergic to any medications or have latex sensitivities.


Please don’t hesitate to call our office with any questions or concerns 926-2300.

 


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