Types of Surgeries

Mohs Surgery - Cutaneous Cancer Removal

Overview

Cutaneous cancers are a type of skin cancer that can be removed through surgery. This surgery is known as Mohs surgery (otherwise known as Mohs micrographic surgery), and is typically an outpatient surgery (meaning that the patient can go home by the end of the day or the next morning.). The goal of the surgery is to remove the cancer little by little, removing as little tissue as possible, until no cancer remains. This procedure removes the cancer and the surrounding damaged tissue, while leaving as much healthy tissue as possible.

Why?

The most common skin cancers treated by Mohs surgery are basal cell carcinoma, squamous cell carcinoma. Typically, we’ll see surgeons performing Mohs surgery for skin cancers that have a high risk of recurrence, are located in sensitive areas where you would typically want to retain healthy tissue (eyes, ears, nose mouth, hands, feet and genitals), or have a surface area that is hard to define (i.e., the borders of the cancer are hard to see).

 All surgeries, whether they be big or small, carry risks. For Mohs surgery, these typically include:

Risks

Risks of Surgery

  • Infection
  • Pain, swelling, itchiness, or tenderness at the site of the incision.
  • Excessive bleeding.
  • Loss of sensation surrounding the surgical area if nerve endings need to be cut. This may be temporary or permanent depending on the damage
  • Development of keloids post-op (raised scarring).

What to expect prior to your surgery

You may need to take antibiotics before surgery. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems.

Most Mohs surgeries last a few hours. However, you should be aware that it’s not possible to predict how long a Mohs procedure will take. This is because it can be fairly difficult to tell just how extensive the cancer/tumor is just by looking at it at the skin’s surface.

Before the surgery begins, the nurse will clean the affected area. Then, local anesthetic is used to freeze the area, which numbs the skin. This is so that you won’t feel any discomfort during the procedure.

The procedure

Once the local anesthetic takes effect and the skin is sufficiently numbed, the surgeon will start peeling away layers of the skin with a scalpel. A bandage is then placed around the site while the tissue is taken to a laboratory to check if there are still cancerous cells in the sample. If cancer remains, the Mohs procedure will continue. Once all cancerous layers are removed, your wound may be left to heal on its own, stitched, covered by adjacent skin, or be prepped for skin graft depending on how much tissue was removed.

After the procedure

One of the benefits of Mohs surgery is that you will know that all cancer has been removed from your skin. Follow-up appointments and visits with your surgeon or referring doctor may be required to monitor the progress of your recovery. Moreover, follow-up appointments with a dermatologist or skin specialist may be necessary to screen for additional skin cancers on your body. Those who are predisposed to skin cancer will develop another skin cancer within five years. You should have a skin exam performed at least one-to-two times a year to be on the safe side.

 

Recovery time for a Mohs procedure will vary, but you should feel back to normal within a few days to weeks depending on how the wound was closed. Be sure to keep the area clean and dry to avoid the possibility of infection. Itchiness or soreness is common, however let your doctor know if you experience swelling or excessive pain.

Lastly, know that there is a high likelihood you will be left with some kind of scar.

You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.

You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.

Did you know we have a support group?

Your questions and concerns have most likely been asked and answered in our support group. Moderated by our dietitian's, nurses, and staff. We provide you with reliable patient education and resources to help you throughout this life-changing process.