Surgeons use Mohs surgery (Mohs micrographic surgery) to treat skin cancer. This precise surgical procedure allows the surgeon to remove as much malignant tissue as possible while leaving the healthy tissue surrounding it intact. The surgeon removes the layers of skin one by one and examines them under a microscope during the operation until all the cancerous tissue has disappeared. This reduces the chance of future treatments or surgeries. Frederick Mohs developed the treatment in the 1930s.
- Applications of Mohs surgery
- Contraindications of surgical procedure
- Disadvantages of Mohs Surgery
- Preparing for the operation
- Planning the procedure
- On the day of surgery itself
- Procedure
- After the operation
- Prognosis
- Risks
Applications of Mohs surgery
Surgeons use Mohs surgery to treat skin cancer. This is the most effective treatment for two of the most common types of skin cancer, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In addition, the doctor sometimes also uses this surgical procedure to treat other forms of skin cancer, such as some types of melanoma and rare forms of skin cancer such as dermatofibrosarcoma protuberans.
Mohs surgery is recommended in these situations :
- The skin cancer is likely to return or has already returned since the last treatment.
- The cancer is in an area of the body where it is important to maintain as much healthy tissue as possible, such as around the eyes, ears, nose, mouth, hands, feet, nipples, areola and genitals.
- The cancer is especially large or growing quickly/aggressive.
- The cancer has uneven edges.
Contraindications of surgical procedure
There are no absolute contraindications to Mohs surgery in patients considered suitable for surgery in general.
Disadvantages of Mohs Surgery
The procedure is sometimes unpleasant for the patient and can become lengthy; especially when it concerns a difficult or complex operation. The procedure also requires a specially trained dermatologist and support staff. Finally, multiple injections of a local anesthetic (numbing medication) may cause discomfort for the patient.
Preparing for the operation
The doctor needs a medication list from the patient / Source: Stevepb, Pixabay
Planning the procedure
The surgeon discusses with the patient Mohs surgical technique, alternative therapeutic options, possible complications of the procedure, and options for wound care and reconstruction after the procedure. The surgeon also needs information regarding the medications, herbs, supplements and vitamins that the patient is taking because he may need to stop taking them temporarily. Sometimes they cause bleeding more quickly after the operation. The surgeon also needs the patient’s medical history.
On the day of surgery itself
Furthermore, the patient wears the best comfortable clothing on the day of the operation. It is also best for the patient to take a book, music or something else with him to pass the time because the removed tissue is analyzed in a laboratory after the surgical procedure and that takes some time. Closure of the wound only takes place after laboratory analysis.
Procedure
The Mohs operation takes place in an operating room with a nearby laboratory. That way, the surgeon is able to easily examine the tissue after it has been removed. The operation usually takes about three to six hours and the patient can go home the same day, although the procedure sometimes takes longer and this is often difficult to estimate in advance. Before the operation, a doctor or nurse will clean the area. The doctor injects local anesthetic into the skin so that the patient does not feel any pain. The surgeon removes the visible part of the cancer with a scalpel. He also removes a thin layer of tissue beneath the visible tumor and then places a temporary bandage. He then takes the tissue to the laboratory where they view it under a microscope. If cancerous tissue is still present, the surgeon removes more layers of skin one by one until the cancer is no longer visible. Cutting away the skin only takes a few minutes, but the analysis takes much longer, sometimes up to an hour.
After the operation
Once the surgeon has removed all the cancerous tissue, he and the patient will discuss options for allowing the wound to heal. Depending on the situation, he applies one of these options:
- allow the incision to heal on its own
- suture the wound
- temporarily close the wound and later perform reconstructive surgery
- taking a flap of skin from a nearby body part to cover the wound
- taking a skin graft from another part of the body to cover the wound
Discomfort, bleeding, redness, or swelling are some symptoms that may occur after the procedure , but these problems usually go away quickly on their own. The doctor provides information about wound cleaning and medication.
It is best for an attendant to take the patient home after Mohs surgery. This certainly applies if the patient has been given sedatives or prescribed painkillers.
Prognosis
Mohs surgery has the highest cure rate of all treatments for basal cell carcinoma and squamous cell carcinoma. More than 99% of new skin cancers and 95% of recurring cancers are permanently removed. The doctor must schedule regular check-ups to check the skin for new forms of cancer because patients who have previously been diagnosed with skin cancer have an increased risk of developing another form of skin cancer.
Risks
Mohs surgery is a very safe procedure, although there are always risks involved, such as:
- bleeding into the wound (hematoma) from the surrounding tissue
- bleeding at the site of the operation
- a thick, raised scar (keloid)
- a skin infection
- itch
- pain or tenderness in the area where the skin was removed
- temporary or permanent numbness in the area where the skin was removed
- temporary or permanent weakness of the surgical area if the tumor is large and a muscle nerve has been severed
read more
- Skin cancer: Malignant skin growths and skin tumors
- Squamous cell carcinoma: Form of skin cancer
- Melanoma: Form of skin cancer caused by sun exposure
- Basal cell carcinoma in the eyelid: Form of skin cancer
- Basal cell carcinoma: Slow-growing form of skin cancer