Mohs surgery was developed by Dr. Frederick Mohs in the 1930’s. He recognized that a skin cancer often resembles the “tip of an iceberg” and that they have more tumor cells that grow deeper and wider, like the roots of a tree. The roots are not visible to the naked eye, but they can be tracked under a microscope. Mohs surgery is a highly precise and specialized treatment for skin cancer that removes the cancer in a “layering” process, one layer of tissue at a time.
Once the location of your tumor is identified, it is numbed with local anesthesia. The entire visible tumor is removed as well as a thin margin of surrounding skin. Any bleeding is stopped and a bandage is placed over the wound. The tissue is taken to the lab, located in our office, where a mohs histotechnician processes the tissue. This process will take, on average, 30-40 minutes. Your Mohs surgeon will then carefully examine the slides under a microscope identifying any remaining tumor. If any tumor is still visible, a map is drawn identifying the location of the remaining roots of your tumor. You are then brought back into the operating room and a second layer of tissue is removed. This process continues until no further tumor is identified. On average, most patients have 2-3 layers taken, depending on the size and depth of the tumor. We cannot predict the extent of your tumor prior to surgery, therefore we cannot predict how long your surgery will take or if you will need a reconstructive procedure afterwards. You should bring things to your appointment to keep you occupied as you may be in the office all day.
Once your skin cancer has been completely removed, your surgeon will discuss with you if the wound will require reconstruction. Often small or superficial wounds can be left to heal on their own (much like a skin biopsy). Other times your wound may require reconstructive (plastic) surgery. Reconstruction is most often done the following day. The reconstruction that is best suited for each individual patient cannot be predetermined because it depends on the size and depth of the wound after the removal of the skin cancer, as well as on each individual’s needs.
We do recommend that you have someone with you to keep you company and to drive you home if necessary as surgery is often stressful and tiring.
Please feel free to call the office if you have any questions about your surgery at 330.239.4350.