Mohs Surgery

What is Mohs surgery?
Mohs surgery, also known as micrographic dermatologic surgery, is the gold standard for skin cancer treatment, especially on head and neck areas. Mohs surgery is especially useful for recurrent, aggressive skin cancers anywhere on the body, and may be used to treat large skin cancers on the trunk and extremities.

Who performs Mohs surgery in your practice?
Mohs surgery is performed only by physicians who have received expert training, often in the form of an additional fellowship after dermatology residency. This training allows us to examine 100% of the peripheral and deep margins of the tumor, using a microscope, and a detailed map during the procedure, while the patient waits.

This gives us superior visualization of the specimen margins compared to other surgical methods. Specimen margins need to be free of skin cancer cells in order to reduce the risk of recurrence of skin cancer.

How to prepare for Mohs surgery?
Before Mohs surgery, it is helpful to avoid pain medications that can cause bleeding, such as ibuprofen and naproxen. Let your Mohs surgeon know if you take aspirin or prescription blood thinners, which also increase your risk of bleeding during surgery. Never stop any medications without consulting the provider that prescribed them for you.

Avoiding smoking and consumption of alcoholic beverages before and after surgery is very helpful.

How does the Mohs surgery procedure work?
During the Mohs procedure, the patient is anesthetized using local anesthesia injected into the skin. Since the patient is awake during Mohs surgery, there may be a slight sensation of pressure and movement of the skin without pain.

After the skin cancer is removed with the scalpel and bleeding has been controlled, the patient will have a bandage placed over the open wound and rest comfortably while waiting. While the patient is waiting, the specimen is processed using a cryostat, which is a machine that the Mohs technician uses to freeze and cut thin slices of tissue.

How long does the procedure take?
Specimen processing with a cryostat can take on average 30 to 60 minutes per stage. This includes time spent by the Mohs surgeon reading the slides under the microscope. If a particular stage of Mohs surgery reveals residual skin cancer, then another layer of tissue and an additional stage of surgery is taken. For this reason, it is not possible to predict exactly how long any particular Mohs procedure will take.

Most patients will complete the Mohs procedure and subsequent reconstruction of the wound or defect in several hours. Once the skin cancer has been completely removed with the Mohs procedure, the wound is sutured using a variety of techniques employed by the Mohs surgeon.