Mohs surgery has come to be accepted as the single most effective technique for removing Basal Cell Carcinomas and Squamous Cell Carcinomas (BCCs and SCCs), the two most common skin cancers.
Nathan J Cleaver D.O. completed a fellowship at Northeast Regional Medical Center specializing in this technique. Without question, this technique has given the medical field an advantage in treating non-melanoma skin cancers of the head and neck. Initially developed by Dr. Frederick Mohs in the 1930s, Mohs micrographic surgery has become the gold standard in treating these types of cancer in the 2000s.
Today, Mohs surgery has come to be accepted as the single most effective technique for removing Basal Cell Carcinomas and Squamous Cell Carcinomas (BCCs and SCCs), the two most common skin cancers. It spares the greatest amount of healthy tissue while also ensures the highest clearance of cancer cells; cure rates for BCC and SCC are an unparalleled 99 percent or higher with Mohs, significantly better than the rates for standard excision or any other accepted method.
The reason for the technique’s success is its simple elegance. Mohs differs from other techniques in that microscopic examination of all excised tissues occurs during rather than after the surgery. The standard surgical margin for excisions on the arms, trunk and legs is at least 4 mm on each side of the tumor. However, in this technique, the margin is determined clinically, and by microscopically examining the margins of the skin cancer that is removed, the Mohs surgeon is able to remove all of the cancer cells while sparing as much normal tissue as possible. The procedure entails removing one thin layer of tissue at a time; as each layer is removed, its margins are studied under a microscope for the presence of cancer cells. If the margins are cancer-free, the surgery is ended. If not, additional tissue is removed at the margin where the cancer is still present, and the procedure is repeated until all the margins of the final tissue sample examined are clear of cancer. In this way, Mohs surgery microscopically assists in skin cancer removal, producing the best therapeutic and cosmetic results.
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THE ADVANTAGES OF MOHS SURGERY
Mohs surgery is unique and so effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. The pathologic interpretation of the tissue margins is done on site by Dr. Cleaver, who is specially trained in the reading of these slides and is best able to correlate any microscopic findings with the surgical site on the patient.
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Ensuring complete cancer removal during surgery, virtually eliminating the chance of the cancer growing back
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Minimizing the amount of healthy tissue lost
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Maximizing the functional and cosmetic outcome resulting from surgery
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Repairing the site of the cancer the same day the cancer is removed, in most cases
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Curing skin cancer when other methods have failed
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Mohs surgery has the highest success rate of all treatments for skin cancer—up to 99%.
HOW TO PREPARE FOR YOUR SURGERY
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If your skin cancer is located in the center of your face, eyelid, or eyebrow area where a bandage will block your vision or impact your ability to wear glasses, please have someone available to drive you to and from the office.
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You may eat a normal breakfast or lunch on the day of surgery.
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Wear comfortable clothing. You will be required to remove your shirt. Please, one-piece outfits.
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Do not apply makeup, perfume, aftershave, or cologne the day of surgery.
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For surgery, consultation, and analysis prepare to be in our office for 2-4 hours. Some patients may be required to stay longer.
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Take all of your routine medications, with the exception of any medications that we have told you to stop.
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If you are unable to make it to your scheduled appointment, please call our office at least 48 hours in advanced so we may reschedule your appointment.
YOUR SURGERY DAY
After you arrive in the office, one of our nurses will greet you and take you to the treatment room where the Mohs procedure will be performed. They will take your blood pressure and ask about your medications and allergies. Dr. Cleaver will be in to greet you before the start of the procedure and answer any last minute questions.
Local anesthesia is administered around the area of the tumor, as the patient is awake during the entire procedure. The use of local anesthesia in Mohs surgery versus general anesthesia provides numerous benefits, including the prevention of lengthy recovery and possible side effects from general anesthesia. After the area has been numbed, the Mohs surgeon removes the visible tumor along with a thin layer of surrounding tissue. This tissue is prepared and put on slides by a technician and examined under a microscope by the Mohs surgeon. If there is evidence of cancer, another layer of tissue is taken from the area where the cancer was detected. This ensures that only cancerous tissue is removed during the procedure, minimizing the loss of healthy tissue. These steps are repeated until all samples are free of cancer.
Once Dr. Cleaver is confident that the skin cancer has been completely removed, he will discuss the options to repair the wound. Most often the wound can be closed in a linear fashion with stitches. This turns the circular hole in the skin into a fine straight line (scar). In other cases, a more complex procedure known as a flap or graft may be required to provide the best possible cosmetic result. This decision will depend on the wound size, depth, and location. If the wound is stitched up, the stitches are removed typically one week later, though this may vary from patient to patient.
On the day of your surgery, please bring an updated list of medications and any medications you may need to take during the surgery time. Patients typically bring a book to read or headphones to listen to music or podcasts.
MOHS RECOVERY
Dr. Cleaver will provide specific post-operative wound care instructions. Recovery is usually very easy and uneventful. Most patients are able to return to work or school the next day after Mohs. Swimming, heavy lifting and exercise is not permitted until after the sutures are removed. You may resume showering the morning after surgery. Pat the wound dry after leaving the shower and reapply the medication and bandage.
Finally, while Mohs surgery has the highest success rate of all treatments for skin cancer it is important to understand that no cancer treatment or surgery has a 100% cure rate. There is a very low chance (1-2%) that your skin cancer will recur after Mohs surgery.
RESOURCES
American Academy of Dermatology
American Society for Mohs Surgery