The purpose of Mohs surgery is to completely remove all cancerous tissue while preserving as much healthy skin as possible. The cancer is removed one layer at a time while examining each layer under the microscope. Both the depth and the borders of the tissue are evaluated thoroughly until all margins are clear of tumor.
The meticulous examination and control of removed tissue provides the following benefits:
What does “Mohs” stand for?
Mohs is actually not an acronym, as many believe. The procedure is named after Dr. Fredrick Mohs, Professor of Surgery at the University of Wisconsin, who developed the surgical technique. This technique has undergone many refinements through the years and has come to be known as Mohs surgery in honor of Dr. Mohs.
What is Mohs surgery?
When we identify skin cancer by biopsy, it can often be that what we see on the surface is only a small portion of what is actually there. Dr. Mohs developed the Mohs surgery technique as a way of identifying and removing all the tumor that is present. With this technique the tumor is removed in stages, one “layer” at a time. Once a layer is removed, the tissue is processed in a very specific way and then examined under a microscope by your Mohs surgeon. This process is repeated as many times as necessary until the entire tumor is removed
It is this unique processing and the fact that the Mohs surgeon themselves examine the slides, that make the Mohs surgery technique so effective. While other physicians may claim to be doing Mohs surgery, it is clearly not the same if they are not processing the tissue using the Mohs technique and they are not reading the histopathology themselves. Our Mohs surgeons are Board Certified Dermatologists that hare also Fellowship trained in the Mohs surgery technique, and strive to provide the best possible treatment of your skin cancers using this technique.
Will the Mohs surgeon be able to evaluate other lesions on my surgery day?
No. The best way to assure that your biopsy-proven skin cancer is treated appropriately is to focus on that procedure on your surgery day. For this reason, your Mohs surgeon will defer the diagnosis and treatment of any other lesions or skin conditions to the very capable care of our General Dermatologists here at May River Dermatology.
Can I have all my skin cancers treated at one surgical visit?
No. It is not uncommon that your latest dermatology visit revealed multiple skin cancers. But we cannot let the knowledge of multiple issues divert us from providing safe and effective treatment. Mohs surgery will create significant defects that will require significant repair and significant healing time. These wounds also come with significant recovery time and significant infection risk. We help to manage these issues by limiting you to one surgical issue per visit. We here at May River Dermatology will work with you to treat all your lesions as effectively and efficiently as possible, and that will likely require multiple office visits and multiple surgical appointments.
My biopsy site has completely healed, so do I still need Mohs Surgery?
Yes. While it may look like all your skin cancer is gone, studies have shown that that is almost never the case. Even when our naked eye cannot see any residual cancer, there can still be some in the area that will certainly return if untreated. Mohs surgery will utilize a microscopic examination of the tissue that is removed to assure complete removal of all the cancerous cells in the area.
Will I have a scar?
Yes. As with any other surgical procedure, there will be a scar. While Mohs surgery does preserve as much healthy skin as possible, there will be a scar after the area has healed. The exact size and shape of the scar will be dependent on the size and location of the actual defect left behind once all the skin cancer has been removed by Mohs Surgery. The possibilities are many, including flat scars from letting the area heal in without sutures, linear scars from a straight-line repair, and complex scars from the flap and graft repairs.
Why is the scar bigger than the biopsy spot?
The biopsy was just a sample of the original lesion and was never intended to define the entire area that needs treatment. With Mohs surgery, your surgeon will be able to define all areas of skin cancer that need to be removed. And while Mohs surgery does allow for removal of the least amount of unaffected skin, it does still require a margin of normal skin to be removed to ensure the best chance that cancer does not recur. Thus, the defect after completion of Mohs surgery is normally larger than the biopsy site.
Why do I need to use Hibiclens soap?
It is normal for all the skin on our bodies to have bacteria. Studies have shown that if we can decrease this normal bacterial burden prior to a surgical procedure, then we can decrease the chance for an infection after surgery. This has been shown that it helps even if the area you are having surgery is not directly washed with the soap! In other words, any amount of decrease in our overall bacterial burden can help decrease the chance of infection in any site. This is why we recommend that all our patients wash with Hibiclens soap prior to surgery, and use the soap as a body wash the week of surgery as well.
If Hibiclens helps reduce infection, then shouldn’t I wash my wound with it after surgery as well?
No. While Hibiclens soap does help decrease bacterial burden, it is also very irritation to an open wound. This irritation can slow wound healing and mimic the signs of infection during the post-operative period. Thus, we recommend that you use the Hibiclens as a general body wash in the post-operative period, but that the wound itself should be cleaned with gentle soap and water or hydrogen peroxide.
Will May River Dermatology give me bandage supplies for after my surgery?
No. Our staff will put a complex pressure bandage on your defect immediately following the completion of your Mohs surgery procedure that will remain in place for 24 hours. While you are in the office, they will give you excellent verbal and written instructions on the wound care that you will begin after that first 24 hours. They will make recommendations of any bandaging supplies that you may need during your post-operative period, all of which can be purchased at any major pharmacy.
Will I be able to play golf or tennis the next day?
No. While Mohs surgery is able to be done in an outpatient setting, it is still a surgical procedure and will require significant recovery time before the wound from your surgery is able to stand up to normal physical activity. All forms of exercise, including golf and tennis, involve significant muscle strain, bending over, and increase in blood pressure which will slow or even prevent proper wound healing. In the worst-case scenario, you can even cause your surgical repair to open up which will then lead to increased risk for infection, longer recovery periods, and more significant scarring.
The length of time that you will need to decrease your physical activity will vary based upon the type of surgical repair your wound requires. This time of minimal strenuous or athletic activity can be as short as a few days with second intention healing that requires no sutures, to 2 weeks for a large flap reconstruction. Your Mohs surgeon will advise you on the proper amount of time for decreased activity based on the final outcome after completion of your surgery.
Is there anything that could prevent me from getting surgery on my scheduled surgery day?
Yes. There are multiple medical problems that can prevent you from being able to complete your surgery as planned. The most common reasons we see are blood pressure elevated to unsafe levels BEFORE we even start the surgery, and failure to take preoperative antibiotics when required. The best way to make sure your surgery goes as planned is to follow all instructions as given when you are called to schedule your surgical visit. If you have any questions before your surgery date, it is always better to call and clarify any instructions or restrictions. For your safety and best outcomes, we will always choose to delay surgery when it is in the interest of your health and safety.
Please contact our office regarding questions on other surgical procedures.