Mohs surgery is a type of cancer treatment that has the highest cure rate for basal cell and squamous cell carcinoma. It also spares healthy tissue and results in smaller scars.
For this reason, Mohs is the preferred treatment for many patients with skin cancer. However, it’s not routinely used for melanoma.
What is Mohs surgery?
Mohs surgery is a highly effective treatment for melanoma and other skin cancers. It is the gold standard in removing basal cell carcinomas and squamous cell carcinomas, with a cure rate that is more than 99% for new tumors and more than 95% when cancer comes back.
During the procedure, the surgeon removes the visible part of the melanoma and a thin layer of tissue immediately surrounding it. Then the doctor examines this tissue under a microscope to see if any cancer cells are present. If any are found, the doctor removes another layer of tissue and repeats this process until no traces of cancer remain.
The whole procedure is performed in a doctor’s office or an outpatient surgical center and may take several hours. The first step is to numb the area with a local anesthetic.
Your provider will then take a small sample of the affected area and freeze it, so that it can be read under a microscope. If the cancer cells are still present, they will be marked on a map and another layer of tissue will be removed until no more cancerous tissue is detected.
This process can take several hours, but it is important that all of the cancerous cells are removed so that no additional treatments or surgery will be needed. Also, the fewer layers of skin that are removed during this procedure, the less damage to healthy tissue will be done, reducing the chance that the cancer will come back.
When the surgery is complete, a bandage will be placed over the wound. You can usually return home within a few days, but it will take a while for the wound to heal completely.
The surgeon will give you instructions for caring for the wound. You will need to follow them closely until the sutures are removed (usually 5-7 days after surgery).
If you have any questions or concerns about your recovery from Mohs surgery, ask doctor Rokhsar or health care team. You will likely need to keep the area clean and apply antibiotics after the surgery to reduce your risk of infection.
How does Mohs surgery work?
Mohs surgery is a very precise way to remove skin cancer. It is used to treat most basal and squamous cell skin cancers, including melanoma. The technique works well to prevent recurrence, because it removes only the tumor tissue and spares as much healthy skin as possible.
To start the procedure, your doctor numbs the area with medicine. Then, the surgeon or a technician cuts out the visible portion of the tumor and the surrounding tissue. This sample is taken to a laboratory where it’s examined under a microscope. If cancer cells are found, your surgeon removes more tissue in the positive areas and examines it again under the microscope. This process continues until all of the tumor is removed and cancer cells are no longer seen.
After the tissue is removed, it is frozen, sliced into very thin sections and processed onto slides by a Mohs histotechnician. These slides are then inspected by the surgeon to make a map of all of the removed cancer tissue.
The surgeon uses the map to determine where the remaining cancer cells are located and removes more tissue in those areas only. This is called a “negative histologic margin” and ensures that all of the cancer has been removed.
In most cases, the surgery takes about four hours to perform. But it can take longer, so you’ll need to set aside a whole day for the procedure.
Once the surgeon has completed the procedure, you’ll leave with a bandage over your wound to keep it clean and free of bacteria. You can wear the bandage for a week or more, but you may need to change it regularly to make sure that it’s protecting your skin and keeping the infection under control.
Your doctor will give you instructions about how to care for your skin after the surgery. You can also go back to the same doctor for a follow-up appointment.
You’ll likely want to avoid the sun for a few days after the procedure. If you do go out, be sure to cover the affected area with sunscreen. This will help the skin heal better, and keep it from becoming more prone to recurrence.
What are the risks of Mohs surgery?
If you have skin cancer, Mohs surgery can be a powerful treatment option. The procedure has a cure rate of 99% and is highly effective at removing malignant cells from the skin. The procedure also minimizes scarring and disfigurement.
This is because the surgeon removes each thin layer of tissue one at a time, and then evaluates it under a microscope to make sure that all cancerous cells have been removed. This technique is very thorough, which maximizes the chances of eradicating every microscopic melanoma cell in the tumor.
The technique is especially useful when skin cancers have ill-defined borders or have a high risk of recurrence. It is also used to treat skin cancer that was previously treated by radiation or other methods.
During the first step of the procedure, your dermatologist will use a local anesthetic to numb the affected area. Your skin may bleed, but this is normal and usually stops when the procedure is complete.
Next, the skin cancer is removed and examined under a microscope. If cancer is found, the doctor will repeat the process until a tissue sample shows no signs of disease.
Once the tissue is free of cancer, your surgeon will repair it. Sometimes a skin flap or skin graft from another part of your body is used to close the wound.
Your surgeon will discuss the type of surgery that is right for you. You will need to take antibiotics before and after the procedure to prevent infection. You may have some mild pain after the surgery, but this should subside quickly if you follow your doctor’s instructions.
If you are a good candidate for the Mohs surgery technique, your dermatologist will give you instructions on how to care for your surgical site. This includes what to do if you experience any problems, such as bleeding, redness or swelling.
You can also ask your surgeon if you should use an antibiotic after the surgery to prevent infections. Your doctor may prescribe this if you have a history of certain bacterial infections, such as strep throat or pneumonia.
What is the success rate of Mohs surgery?
The cure rate of Mohs surgery is high, and it’s a fast, simple procedure that removes cancerous tissue while leaving healthy tissue behind. This makes Mohs a great choice for treating small, non-invasive skin cancers on areas of the body where the normal tissue is vital for appearance and function.
During the surgery, the doctor or other technician will take a thin layer of tissue from the area of concern and examine it under a microscope. If cancer cells are found, the doctor will remove another layer of tissue and look at it again.
This process is repeated until the doctor no longer finds any cancer cells. The doctor then stitches the area and closes it, allowing the wound to heal naturally.
Although Mohs is an excellent option for treating non-melanoma skin cancers, it’s not as effective for melanoma because a doctor must be very careful to remove the smallest amount of tumor without destroying normal tissue. This is because melanoma can spread to other parts of the body.
So, doctors may opt for a different type of surgery instead. That’s why not all doctors agree that Mohs is the right option for melanoma, even though it’s used more often for other types of skin cancer.
But if you have an especially large or difficult-to-diagnose skin cancer, your doctor might decide that Mohs surgery is the best way to treat it. A recent study, which compared Mohs surgery with wide local excision for melanoma in situ, found that both methods had high success rates.
Despite the higher cure rate, patients still worry about recurrence and other issues associated with melanoma. But the new research shows that recurrence rates are lower for Mohs surgery than for wide local excision.
This is because the surgeon uses very specific techniques to identify and remove the smallest amounts of tumor without damaging normal tissue. This also allows a smaller scar to be formed and reduces the chance of recurrence.
The surgery is a bit more time consuming than wide local excision, but it’s worth the extra effort because it conserves more normal tissue. The procedure is also more precise, allowing the surgeon to confirm that all tumor has been removed before stitching up the wound. That’s important because a recurrence of skin cancer can be deadly.