Mohs surgery is a precise surgical technique for removing certain skin cancers. It excels in excising cancerous tissue while preserving surrounding healthy skin. This method is particularly beneficial for skin cancers on the face, head, neck, hands, feet, and genitals, where tissue preservation and cosmetic outcome are important.
This specialized approach offers high cure rates (up to 99% for new BCC and 95-99% for SCC). The process allows for complete microscopic examination of tumor margins, ensuring all cancer cells are removed.
Preparing for Mohs Surgery
Before Mohs surgery, patients receive specific instructions. Continue most prescribed medications, including those for blood pressure or diabetes. However, discuss all medications and supplements, especially blood thinners like aspirin, ibuprofen, vitamin E, or fish oil, with your surgeon, as some may need adjustment to minimize bleeding risk.
Eat a normal breakfast before the procedure. Wear comfortable, loose-fitting clothing, avoiding makeup, perfume, or jewelry near the surgical site. Since the procedure can take several hours, consider bringing snacks, drinks, reading material, or an electronic device. Arrange for transportation home, especially if the surgery site is near the eye or if relaxing medication is administered.
The Mohs Surgery Process
Mohs surgery is an outpatient procedure, typically performed in a medical facility with an on-site laboratory. The surgeon identifies the biopsy site and outlines the area to be treated. A local anesthetic is then injected to numb the surgical area, ensuring comfort, though a brief stinging sensation may be felt.
Once the area is numb, the surgeon removes the visible portion of the tumor along with a thin layer of surrounding tissue. This initial tissue layer is carefully mapped, color-coded, and immediately taken to an on-site laboratory for processing. Technicians rapidly freeze and section the tissue, allowing the Mohs surgeon to examine 100% of the margins under a microscope for any remaining cancer cells.
Patients typically wait in a comfortable lounge area while the tissue is analyzed, which can take approximately 30 minutes to an hour per layer.
If cancer cells are detected at any margin, the surgeon uses the precise map to return to the patient and remove another thin layer of tissue only from the exact area where cancer remains. This staged process continues, with additional tissue removal and microscopic examination, until no cancer cells are observed in the margins.
The entire procedure can last several hours, often between three to four hours, but may extend longer depending on the cancer’s size and complexity. After all cancer is removed, the surgeon will discuss options for closing the wound, which can include stitches, a skin graft, or allowing it to heal naturally, often performed on the same day.
Life After Mohs Surgery
After Mohs surgery, expect mild discomfort, swelling, and bruising, which typically peak within 24 to 72 hours. Over-the-counter pain relievers like acetaminophen are usually sufficient. Avoid aspirin or ibuprofen unless directed due to increased bleeding risk. Applying ice packs around the wound can help minimize swelling and discomfort.
Wound care instructions are provided by the surgeon for proper healing and infection prevention. The initial dressing should remain undisturbed for 24 to 48 hours. After this period, clean the wound gently with soap and water, then cover with a thin layer of petroleum jelly or antibiotic ointment and a fresh dressing. Keep the wound moist, avoid scabs, and change the dressing daily or as instructed.
Activity restrictions are common during the recovery period to prevent complications like bleeding or poor wound healing. Patients are generally advised to avoid strenuous exercise, heavy lifting, and bending over for at least one to two weeks, especially if the surgery was on the head or neck. Complete healing can take 4 to 10 weeks, with scars continuing to mature and fade for 12 to 18 months. Contact your doctor for signs of infection such as increasing redness, swelling, pain, pus, or fever, or if bleeding persists despite pressure.