Mohs surgery is a specialized medical procedure often recommended for certain skin cancers. Understanding its unique approach can alleviate concerns about its perceived seriousness. It is a precise and effective treatment designed to remove cancerous tissue while preserving healthy skin.
Understanding the Mohs Procedure
Mohs surgery is a precise technique for removing skin cancer layer by layer. The surgeon removes a thin layer of visible cancerous tissue and a small margin of surrounding skin. This tissue is immediately examined under a microscope in an on-site laboratory. The process continues, with the surgeon removing additional thin layers only from areas where cancer cells are still detected, until no cancer cells remain. This meticulous method preserves healthy tissue while completely eliminating cancerous cells.
Mohs surgery primarily treats basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the two most common types of skin cancer. It is often recommended for cancers in cosmetically sensitive or functionally important areas, such as the face, ears, nose, lips, hands, feet, and genitals. The procedure is performed in an outpatient setting under local anesthesia, meaning the patient remains awake.
Recovery and Aftercare
Recovery from Mohs surgery is generally manageable, performed on an outpatient basis. Most patients experience mild to moderate pain or discomfort, managed with over-the-counter pain relievers like acetaminophen or ibuprofen. Swelling and bruising around the surgical site are common, subsiding within a few days to a week. Applying ice packs and elevating the surgical area can help minimize these effects.
Proper wound care is essential for optimal healing. Patients keep the initial bandage dry for 24 to 48 hours. Daily cleaning of the wound with mild soap and water, followed by antibiotic ointment or petroleum jelly, is recommended. The wound should be covered with a non-stick dressing.
Stitches, if used, are removed within 7 to 14 days, depending on location and healing. Patients avoid strenuous activities, heavy lifting, and bending over to prevent bleeding and promote healing. Complete healing can take several weeks to months, with scar maturation over 12 to 18 months.
Effectiveness and Outcomes
Mohs surgery is recognized for its high success rates in treating skin cancer. For new basal cell carcinomas, the cure rate is as high as 99%, and for recurrent cases, it is up to 94%. For squamous cell carcinomas, the cure rate ranges from 95% to 99% for new cases and approximately 90% for recurrent cases. This effectiveness stems from the precise microscopic examination of 100% of the tumor margins, ensuring all cancer cells are removed during the procedure.
The tissue-sparing nature of Mohs surgery contributes to better cosmetic outcomes compared to traditional excision methods. By removing only cancerous tissue and preserving healthy skin, the procedure often results in the smallest possible scar. This is beneficial for cancers on the face or other visible areas. Confirming complete cancer removal during the same visit provides immediate reassurance to patients.
Potential Side Effects and Considerations
While Mohs surgery is generally safe, patients should be aware of potential side effects, which are manageable. Common side effects include temporary bruising, swelling, and mild pain at the surgical site. Numbness in the treated area can occur if small nerve endings are affected, though this is often temporary. Scarring is an expected outcome of any surgical procedure; while Mohs surgery aims to minimize it, some degree of scarring will occur.
Less common side effects include infection, occurring in 1-2% of cases. Other rare complications may include excessive bleeding, poor wound healing, or nerve damage leading to temporary or permanent weakness. Allergic reactions to surgical tape or local anesthetics are possible. Choosing an experienced Mohs surgeon and following all pre- and post-operative instructions helps mitigate these risks and ensures the best possible healing.