Mohs Micrographic Surgery
This procedure is used to remove skin cancer that affects the face and other sensitive areas. The doctor removes the cancer layer by layer, examining the tissue under a microscope until only healthy tissue remains.
Basal Cell Carcinoma
Reasons for Procedure
- Appear on the face (including eye lids, lips), scalp, ears, neck, shins, hands, fingers, feet, toes, and genitals
- Were previously treated and came back
- Occur near scar tissue
- Are large
- Have poorly-defined edges
- Are growing rapidly
This surgery is an effective and precise way to treat basal and squamous cell skin cancers. It offers a good chance for complete removal of the cancer, while sparing normal tissue.
Complications are rare, but no procedure is completely free of risk. If you are planning to have Mohs surgery, your doctor will review a list of possible complications, which may include:
- Reaction to the local anesthesia
- Damage to nerve endings (temporary or permanent numbness or weakness)
- Itching or shooting-pain sensations
Be sure to discuss these risks with your doctor before the procedure.
What to Expect
Prior to Procedure
In the time leading up to the procedure:
- Discuss with your doctor any allergies or medical problems that you have.
- You will most likely be able to continue taking your medicines. Tell your doctor if you are taking any blood thinning medicines.
- Arrange for a ride home and for help at home.
- Eat normally the day of the procedure.
Local anesthesia will be used. You will not feel pain. You will be awake during the procedure.
Description of Procedure
The area will be cleansed with antiseptic. A local anesthetic will be injected into the area. Using a small scalpel, the doctor will remove the top visible portion of the cancer. Next, the doctor will remove another, deeper layer. The layer will be divided into sections. Each section will be color coded. This will allow the doctor to know exactly where the layer was in the skin.
These sections will be frozen and examined under a microscope for remaining cancer cells. If cancer is found at the edges of the removed layer, the doctor will go back to the precise section. Additional layers will be removed until all areas are cancer free. For larger wound areas, the doctor will close the wound with stitches or a ]]>skin graft]]> procedure. Small, shallow wounds may heal without stitches.
How Long Will It Take?
The surgery will go quickly. You will have to wait while the doctor examines the tissue microscopically. In some cases, this procedure can last for several hours.
How Much Will It Hurt?
You should have minimal discomfort during the procedure. There will be some minor pain during recovery. You will be given pain medicine.
At the Care Center
After the procedure, you may be given pain medicine and an antibiotic. You will be able to leave the same day.
When you return home, do the following to help ensure a smooth recovery:
- Keep the area clean, dry, and protected. Follow your doctor’s instructions for caring for the wound.
- Avoid swimming and soaking in tubs until the area has healed.
- For pain relief, take over-the-counter pain medicine, such as ]]>Tylenol]]>.
- Be sure to attend any follow-up visits. Your doctor will monitor your condition.
- Keep in mind that it is normal for a scar to form. The appearance may improve over time.
- Take steps to prevent skin cancer:
- Use sunscreens with a sun protection factor (SPF) of at least 15.
- Protect your skin from the sun. For example, wear a shirt, wide brimmed hat, and sunglasses.
- Regularly check your skin for changes.
American College of Mohs Surgery
American Society for Mohs Surgery
Canadian Association of Mohs Surgeons
Canadian Cancer Society
American Academy of Dermatology website. Available at: http://www.aad.org/. Accessed February 2, 2010.
American College of Mohs Micrographic Surgery website. Available at: http://www.mohscollege.org/. Accessed March 26, 2010.
American Society for Mohs Surgery website. Available at: http://www.mohssurgery.org/i4a/pages/index.cfm?pageid=1. Accessed February 2, 2010.
Narayanan K, Hadid OH, Barnes EA. Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma. The Cochrane Collaboration website. Available at: http://www.cochrane.org/reviews/en/ab007041.html. Published April 15, 2009. Accessed February 2, 2010.
Last reviewed March 2010 by ]]>Ross Zeltser, MD, FAAD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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