Mohs Micrographic Surgery
Eastern Dermatology and Pathology
Richard Lewis, M.D.

INTRODUCTION
What is Mohs surgery?
     Mohs surgery is a specialized treatment for the total removal of skin cancer. Mohs surgery is named in honor of Dr. Frederic Mohs, the physician who developed the technique. This method differs from all other methods of treating skin cancer by the use of complete microscopic examination of all of the tissues removed surgically as well as detailed mapping techniques to allow the doctor to remove every cancer cell.

     The procedure is performed under local anesthesia in an outpatient setting. The visible cancer and a very thin layer of skin is removed from that exact location. While you are in the office, this procedure will be repeated as often as necessary to remove the cancer.

What are the advantages of Mohs Surgery?
     By using these detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The result is the removal of as little normal skin as possible, and the highest possibility for curing the cancer.

What are my chances for cure?
     Using Mohs surgery, the percentage of cure is more than 99 percent for most skin cancers, even when other forms of treatment have failed. Other methods of treatment offer only a 50 percent chance of success if previous treatments have failed.

What happens the day of surgery?
     Your appointment will be scheduled early in the day. Our staff will escort you into a surgical suite where the area around the skin cancer will be numbed.

     Once it is numb, the visible cancer and a thin layer of tissue will be removed. This tissue is carefully mapped and coded by the doctor and taken to the adjacent laboratory where the technician will immediately process the microscope slides. You will have a temporary dressing placed over the wound and you will be free to return to the waiting room.

     The surgical procedure alone takes only 15-20 minutes. However, it takes 30 minutes to 2 hours to prepare and microscopically examine the tissues of each layer. Several surgical stages and microscopic examinations may be required, and you will be asked to wait in the patient waiting area between stages. Although there is no way to tell before surgery how many stages will be necessary, most cancers are removed in three stages or less.

Will the surgery leave a scar?
     Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we will decide on the most appropriate method of repair. This decision is based on the safest method that will provide the best cosmetic result.

AFTER SURGERY:
Will I need to come back?
     Usually at least one return visit is needed to examine the healed surgical site or to remove stitches. Afterwards, you may return to your referring physician for routine check-ups.

     A follow-up period of five years for the treated cancer is essential. After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your referring physician at least once a year, not only to examine the treated skin cancer, but also to check for new skin cancers.

How can I protect myself from developing more skin cancer?
     The best protection from skin cancer is to avoid the harmful ultraviolet rays of the sun. Even if you tan easily, the sun can contribute to skin cancer in two ways. First, the sunlight damages the genes that control cell growth, and second, sunlight damages the body's immune system so that early cancers grow unchecked by normal immune defense.

     Minimize your exposure to ultraviolet rays. Using any sunscreen with a sun protective factor (SPF) of at least 30, with UVA/UVB protection when you spend any time in the sun. Also , reapply sunscreen at least every 2 hours, especially after swimming or exercise. Avoid sun exposure during mid-day hours (10 a.m. to 4 p.m.). Do not stay outdoors unprotected on cloudy days since the ultraviolet light penetrates easily through the clouds. Report changing lesions or new spots to your dermatologist. Regular check-ups are important to monitor for new skin cancers.