If you’ve been diagnosed with skin cancer, there’s a good chance your doctor has scheduled you for Mohs surgery. While there are other treatments available, such as superficial radiation treatment (SRT) and topical immunotherapy, Mohs micrographic surgery continues to be the gold standard in skin cancer treatment, with a 99% plus cure rate.
You may have heard about Mohs surgery for skin cancer from your friends or colleagues, or from reading about it on the internet. Maybe you saw the recent headlines that First Lady Dr. Jill Biden is recovering well after her Mohs procedure. Mohs surgery doesn’t have to be scary or stressful. We’ll take the mystery out of it in this blog post.
No Hospital Necessary
We do Mohs right here in our office, making it convenient and less costly for you. Our dermatologists are specially trained in Mohs micrographic surgery, and our success rates are excellent. You won’t have to worry about any special preparations for Mohs surgery, although you may have to stop taking certain medications, such as blood thinners, before your procedure. Tell your doctor about any medications and supplements you are currently taking.
You may have heard that Mohs surgery is an all-day affair. This isn’t necessarily the case. Most of the time, Mohs surgery takes less than four hours, although we recommend that patients clear their schedules just in case. In preparation, you should eat a meal before surgery and bring something to entertain yourself.
What to Expect During Mohs
When you arrive for your appointment, you’ll be settled comfortably in a treatment room. The skin to be operated on is cleaned and outlined with a special pen. You’ll receive a local anesthetic to numb the area so you won’t feel any pain. It can take a few minutes for the anesthetic to take effect. Once it does, your doctor will use a scalpel to remove the visible portion of the cancer. Next, a thin layer of tissue is removed and taken to the onsite lab for analysis. The tissue sample is divided into sections and examined under a microscope. The exact location where each piece of tissue was removed is mapped, so if cancer is found, the doctor knows exactly where to continue the operation. Waiting for lab results is usually the longest part of the procedure.
“It’s very important for us, and it’s the highest prerogative, that we make sure that you leave with the most compassionate experience possible when it comes to the Mohs procedure,” says Dr. Ko. “From the providers — and we’re very lucky to have four doctors that are certified in the Mohs procedure — to all of our ancillary support staff, everyone cares about the patient. We’re there to hold their hands. We’re there to inject the numbing in the most gentle manner possible. We’re here to explain the whole procedure the whole time we’re there.”
If cancer is found, the doctor will once again remove a thin layer of tissue from the area where the abnormal cells were located. The goal is to remove all of the cancer, while sparing as much healthy tissue as possible. This second sample will be analyzed in the same manner as the first. This process continues until the last sample removed is cancer-free. Another shot of local anesthetic may be administered if necessary.
After the Cancer is Removed
One of the most exciting benefits of Mohs surgery is that you don’t have to wait to find out that you are cancer-free—you get the results immediately, during your procedure.
Once all of the cancer has been removed, your doctor will determine how to best treat your wound. If it’s not deep, it may be able to heal on its own. You might receive stitches or, if the wound is large, a skin graft. In more complex cases, other practices may close the wound temporarily and schedule a second surgery to repair it. At Arizona Dermatology, we do wound repair on the same day for improved healing and less inconvenience to you.
At Home after Mohs Surgery
Follow your post-surgical instructions to maximize healing and minimize scarring. You’ll probably need to wear a bandage for a week or so following your Mohs procedure. You may experience mild pain or soreness that can be treated with over-the-counter pain medications. Your pain should be very manageable.
“We want to make it the best experience possible,” Dr. Ko adds. “We’re here not just to remove the skin cancer, but to do it in a way where we allay everyone’s concerns, and people realize that, well, that wasn’t as bad as I thought.”
Complications from Mohs are rare and don’t tend to be serious. Watch for excessive pain, bleeding, or signs of infection. Our staff will schedule a follow up appointment so your doctor can ensure that your wound is healing properly. After that, your next visit will likely be for a skin cancer check in about six months!