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Mohs Micrographic Surgery StepsMohs Micrographic Surgery is a specialized microscopically controlled technique utilized to treat the most common forms of skin cancers. It allows skin cancer to be removed with less damage to the healthy surrounding skin while also minimizing the chance of any recurrence.

Mohs surgeons have specialized skills in dermatology, dermatopathology and excisional and reconstructive surgery. While a number of options to treat skin cancers exist, it’s important to recognize that your surgeon is fellowship-trained in this specific technique so that your skin cancer can be removed with confidence. At Quincy Medical Group, our Mohs unit is led by a fellowship-trained Mohs surgeon, Sumul Gandhi, MD, FAAD, as well as a staff that specializes in treating patients with skin cancer.

Mohs surgery takes place in a regular outpatient office setting. The surgery is started in the morning and is generally completed in one day. Sometimes, if the tumor is large, it could take two visits.

During the procedure, the Mohs surgeon removes cancer one layer of skin at a time and tracks its course microscopically until all cancer has been removed. Mohs surgery differs from standard surgical treatment in that 100% of the margins of excised tissue are examined in Mohs surgery, while standard excision examines <1% of the margin. This enables Mohs surgery to offer a higher cure rate when compared to standard excision with margins and also allows preservation of healthy, unaffected skin.

Why The Mohs Micrographic Surgery Procedure Is Performed

Mohs surgery can be used for most skin cancers, such as basal cell or squamous cell skin cancers.

Mohs Surgery May Be Preferred When The Skin Cancer Is On An Area Where:

  • It is important to remove as little tissue as possible, such as the eyelids, nose, ears, lips, or hands.
  • Your doctor needs to be certain the entire tumor is removed before stitching you up.
  • There is a scar or prior radiation treatment was used.
  • There is a higher chance the tumor will come back, such as on the ears, lip, nose, eyelids, or temples.

Mohs Micrographic Surgery May Also Be Preferred When:

  • The skin cancer was already treated, and it was not completely removed or it came back.
  • The skin cancer is large, or the edges of the skin cancer are not clear.
  • Your immune system is not working well due to cancer, cancer treatments, or medicines you are taking.

How The Procedure Is Performed:

  • Numb your skin where cancer is so you do not feel any pain. You stay awake for the procedure.
  • Remove the visible tumor along with a thin layer of tissue next to the tumor.
  • Look at the tissue under a microscope.
  • Check for cancer. If there is still cancer in that layer, the doctor will take out another layer and look at that under the microscope.

This procedure will be repeated until there is no cancer remaining in a layer. Any bleeding will be stopped by applying a pressure dressing, using a small probe to heat the skin(electrocautery), or through stitches.

Processing of Mohs tissue is a long process. Plan to be at the clinic for several hours. Bringing snacks and something to occupy your time is highly recommended.

Before The Procedure

Your doctor will explain what you should do to prepare for your surgery.

You May Be Asked To:

  • Stop taking certain medicines, such as aspirin or other blood thinners. However, DO NOT stop taking any prescription medicines unless your doctor tells you to stop.
  • Stop smoking.
  • Arrange to have someone take you home after your surgery

After The Procedure

Taking proper care of your wound after surgery will help your skin look its best. Your doctor will talk with you about your options including:

  • Let a small wound heal itself.
  • Use stitches to close the wound.
  • Use skin grafts. The doctor covers the wound using skin from another part of your body. The skin near your wound matches in color and texture.

Risks

Mohs surgery is generally safe. With Mohs surgery, you do not need to be asleep (general anesthesia) as you would with other surgeries. While rare, some risks are possible and include:

  • Infection
  • Nerve damage that causes numbness or a burning sensation. This usually goes away.
  • Larger scars that are raised and red, called keloids bleeding.

Outlook (Prognosis)

Mohs surgery “has a cure rate as high as 99% for some forms of skin cancer. With this surgery, the smallest amount of tissue possible is removed. You will have a smaller scar than you might have with other treatment options.

If you have any questions, please call the Quincy Medical Group Dermatology Department at 217-222-6550, ext. 3117 and ask to speak with an employee about Mohs Surgery.