Mohs Microphraphic Surgery FAQ
Surgically Treating Skin Cancer
Mohs surgery, also called Mohs micrographic surgery, is a method of skin cancer removal. The documented cure rate of this procedure is 95 – 99%. The procedure is most often used to treat two of the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma.
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Who should undergo Mohs surgery?
- When the skin cancer is located on a critical structure, such as the eye-lid, ear, nose or lips, or anywhere that preserving the surrounding tissue is critical.
- When skin cancer has recurred after being treated by another method.
- Where the skin cancer has aggressive features
- Where the borders of the skin cancer are very indistinct and it is difficult to see where the cancer ends and normal tissue begins
What is the Mohs Procedure?
The Mohs technique removes very thin layers of skin one at a time and each layer is examined immediately under a microscope. When the layers are shown to be cancer-free, the surgery is complete. The first step is to numb the area with local numbing medicine and then surgically remove the skin cancer. The numbing may cause slight stinging or burning and it reminds some patients of going to the dentist. Only the area that appears to be abnormal is excised first. The physician then takes the sample to a frozen section laboratory and prepares the sample for examination. This process takes at least 20 minutes. Then the sample is examined under a microscope. If cancer is found around the margins of the sample, this procedure is repeated again.
What makes Mohs surgery unique is that the patient waits during this process to allow the physician to completely remove the entire tumor prior to placing sutures. On average it takes two to three stages to remove all skin cancer. It is best however to be prepared to spend an entire day with us in the event that several stages are necessary.
What Happens After the Skin Cancer is Removed?
Once the physician is confident that the cancer cells have been completely removed, the surgical site will then be examined to determine which suturing (if any) is appropriate for optimal healing and cosmetic result. Because we do not know the extent of skin cancer prior to the Mohs procedure, it is difficult to predict what type of repair will be necessary. There are many options, depending on the size of removal. Some wounds are allowed to heal on their own and others require sutures. The extent of suturing depends on the amount of skin cancer removed.
How do I best prepare for Surgery?
Patients who are on blood thinners should check with their primary care physician to see if these can be safely discontinued. It is best to discontinue these medications at least 7-10 days prior to the procedure. Aspirin, including, Anacin, Bufferin, Excedrin, Advil, Alka Seltzer and Pecodan will need to be discontinued also if possible. Alcoholic beverages need to be stopped 48 hours before surgery. The day of surgery, a normal breakfast is recommended. It is also suggested that patients have someone drive them to and from surgery. Bring your insurance card with you to your appointment.
What do I do after the surgery is completed?
If sutures were necessary, the site will need to be bandaged until you return for suture removal. Patients are often able to resume work within one to two days, depending on the nature of the surgery. It is recommended that vigorous exercise is limited for seven days after surgery to allow the wound to heal properly. Excessive exercise may break apart the sutures so that the wound opens up and starts bleeding.
What are possible side effects?
Scars: after any surgical procedure, a scar will occur. Some scars may be pink and bumpy for three to nine months. Scars do improve over time and for those that don’t; the physician will want to re-evaluate the area to determine if additional treatment is needed.
Bleeding or infection: The infection rate is very low for the Mohs procedure. You will be given instructions of what do after the procedure if there is bleeding.
Pain and swelling: After surgery minimal discomfort, bruising, and swelling may be experienced for 5 – 7 days and usually managed with acetaminophen (Tylenol). If pain increases, your treating doctor will want to know.
Numbness: some patients experience numbness around the surgical area. This usually fades with time.
Allergic reaction: any allergy to iodine, tape, or numbing medicine should be reported to the doctor before surgery.
Recurrence: In a very small percentage of patients, tumors may recur. Once you have a skin cancer, we recommend that you have regular followup with your dermatologist to detect and treat any recurrence or additional skin cancers.
Who Performs the procedure?
Linda L. Lutz, M.D.
Assistant Professor of Dermatology
University of Maryland School of Medicine
University of Maryland Medical Center
Dr. Lutz received her medical degree at University of Michigan. She completed her residency in dermatology and fellowship in Mohs Surgery at Cleveland Clinic in Ohio. She is board-certified in dermatology. She has been a member of the University of Maryland School of Medicine faculty since after completion of her fellowship.
The University of Maryland Dermatologists, PA, Faculty Practice of the University of Maryland, School of Medicine provides cutting-edge surgical treatment in a comfortable out-patient setting. The University of Maryland Dermatologists, PA, Faculty Practice of the University of Maryland, School of Medicine serves as a regional center for outpatient and inpatient care for patients with complex cutaneous diseases. In addition to being board-certified, physicians also have faculty appointments at the University of Maryland, School of Medicine. The University of Maryland Dermatologists, PA, Faculty Practice of the University of Maryland School of Medicine partners with the University of Maryland Marlene and Stewart Greenebaum Cancer Center (UMGCC) when necessary to offer a multi-disciplinary approach to care. UMGCC is a National Cancer Institute (NCI) – designated cancer center and ranked 21st out of approximately 900 cancer programs in the country in the U.S. News & World Report’s America’s Best Hospitals list.