Mohs micrographic surgery has the highest cure rate for basal cell carcinoma and squamous cell carcinoma. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of removed cancerous tissue to give assurance that the “roots” of the carcinoma has been eliminated. Mohs surgery is reserved for skin cancers that grow back from previously treated cancers, cancers that are at high risk of reoccurrence, cancers that are located in cosmetic areas where preservation of skin is important (such as the face), and for large skin cancers. This procedure tends to minimize scaring over other therapies with the goal of achieving an optimal cosmetic result with high cure rates.
Mohs surgery is performed by anesthetizing the skin with a local anesthetic followed by removing a thin layer of skin involved with the cancer. This process generally takes about 15 minutes. A cauterizing machine which generates heat will be used to stop the bleeding. The surgical assistant will dress the wound and ask that you proceed to the waiting room while the tissue is being prepared for microscopic examination which takes approximately 1- 1.5 hours. If the examination of the tissue reveals that your tissue still contains cancer cells, the procedure will be repeated. Several surgical excisions and microscopic examinations may be performed in one day. The average number of surgical sessions for most skin cancers is two or three, so most patients are finished by mid-afternoon. When the skin cancer has been determined to be completely removed, recommendations on the best closure choice for the wound will be discussed.
Some patients may feel some discomfort following the surgery therefore taking acetaminophen every four hours is recommended. Avoid aspirin-containing medications or NSAID. Most wounds will ooze a small amount of blood in the first few days. Rarely does significant bleeding occur following surgery however if it should happen, apply firm, continuous pressure for 20 minutes. Swelling is common following surgery, especially when surgery is performed around the eyes. Infrequently, wounds will become infected and an oral antibiotic will be necessary.