Mohs Micrographic Surgery

What is Mohs Micrographic Surgery?

Mohs Micrographic Surgery is a surgical method of removing a skin cancer in thin layers. It is performed by Dermatologists who have additional training in this technique. Because it involves examining the entire undersurface of each layer microscopically for cancer cells, it offers the highest cure rate and the smallest size surgical defect. The number of layers needed to completely remove the skin cancer is determined by the extent and depth of the cancer. There is no way to tell at the beginning how much of a defect might result when the cancer is removed.

What should I expect on the day of surgery?

On the day of surgery, you will come in the morning. It is preferred that you have someone bring you, and depending on the site, this may be mandatory. You may not feel like driving after the procedure. Because we cannot predict the number of “layers” it will take to remove your skin cancer, you may be in our clinic for a few hours or all day. For this reason, we recommend that you bring books, snacks and lunch, company, and other necessities to occupy your time. Please wear comfortable clothing. Each “layer” takes about an hour to process in the lab. The average number of layers required to remove a skin cancer is around 2, though may be more or less depending on your tumor. Family members can wait in your surgery suite with you between layers or they can run errands and communicate with you by phone.

What other options are available for treating skin cancer? Other options (surgical and nonsurgical) are available for removing skin cancers. Other options include but are not limited to radiation, creams, excision, electrodessication and curettage, and injections of immune altering drugs. The primary advantage of Mohs Micrographic surgery is that it is the technique which offers the highest cure rate. In addition, it is a “tissue sparing technique” relative to other surgical methods. These benefits are particularly important for tumors located on anatomically sensitive areas (nose, eyelids, nails, lips, ears) and tumors characterized as being aggressive, recurrent, and/ or ill-defined.

What happens if I don’t treat the skin cancer?

A skin cancer that is left untreated will continue to grow. Depending on the type of skin cancer, it will continue to grow into the surrounding tissue and may even spread. Left untreated, it may lead to significant tissue destruction, near organ damage, and even death.

What happens after the skin cancer is removed?

Following removal of the skin cancer, reconstruction may be required. This may involve putting in stitches, allowing the wound to heal naturally, or placing a graft or flap over the tissue defect. A discussion about the repair options will be conducted, and Dr. Christian will make recommendations based on what she feels will give you the best end result. While the vast majority of reconstructions are conducted in our office by Dr. Christian, in certain instances, we sometimes coordinate with Plastic Surgeons for reconstruction. If for any reason you would prefer this approach, please let us know during your consultation. We will be happy to coordinate with your doctor.

Will the surgery leave a scar?

Unfortunately surgical removal of a skin cancer leaves a scar. However, we will do everything in our power to minimize scarring. We will be happy to work with you over the following 3-6 months to optimize your end result. We sometimes utilize lasers, special dressings, dermabrasion, and other cosmetic techniques to optimize your end result. We will be happy to discuss these with you. However, despite current technology, Mother Nature still plays a role. The way in which a patient heals is in part affected by the location of the scar, the patient’s personal healing response, general health status, and compliance with wound care instructions.

BLOOD THINNERS

1. Many medications (over the counter, herbs, and prescriptions) have a blood thinning effect. When having surgery, they increase the risk of bruising and bleeding.
2. If you started taking any of these medications upon the advice of a physician, do NOT discontinue the medication without first clearing it with the prescribing physician. This includes over the counter medications (Examples: aspirin for stroke or heart attack prevention in high risk patients). If you have any questions about this, please contact our office.
3. It takes 10-14 days for these medications to leave the body and stop thinning the blood. If it is okay with your other physicians, avoid taking any of the medications or herbs on this list for 10 days prior to your procedure. (For aches and pains, Tylenol is a safe alternative and is not a blood thinner).

PRESCRIPTION AND OVER THE COUNTER BLOOD THINNERS:

Acetylsalicylic acid Advil® Alka-Seltzer® Aleve® Anacin® Anaprox® Arthritis Pain Formula® Arthritis Pain Reliever® Ascriptin® products Aspergum® Aspirin products Baby Aspirin Bayer Select® Buffaprin® Bufferin® Clopidogrel Diclofenac Dipyridamole Ecotrin® Empirin® Equagesic® Excedrin® Genprin® Goody's Headache 4-Way Cold® Goody's Tabs-XS® Halfprin® Haltran® Ibuprofen® Indomethacin Indameth® Indocin® Ketorolac Ketoprofen Lanorinal® Medipren® Midol Max Strength® Midol Cramp Formula® Midol IB® Mobic® Motrin® Naprosyn® Naproxen Norgesic® Nuprin® Orudis® Oruvail® Piroxicam Persantine® Plavix® Pletal® Powder 4-Way Cold® Pamprin IB® Rufen® Robaxisal® Roxiprin® Sine-Off® Synalgos® Triaminicin Cold® Trigesic® Ursinus Inlay® Vanquish® Zorprin®

HERBS THAT ARE ALSO BLOOD THINNERS:

Feverfew Garlic Ginkgo biloba Ginger Ginseng Kava St. John's Wort Sulfinpyrazone Valerian Vitamin E Fish Oil