Mohs Micrographic Surgery

What Is Mohs Surgery?

Mohs micrographic surgery is an advanced treatment for skin cancer that allows the physician to carefully remove only cancerous cells, leaving the surrounding healthy skin undamaged. This is possible by examining each skin layer under a microscope to trace the edges of the tumor. Mohs can be especially beneficial for those with a carcinoma that has developed in an area of anatomic or functional importance, such as the eyelids, nose, or lips. In addition to producing a smaller scar, Mohs surgery has a cure rate of over 99%, making it a revolutionary procedure in skin cancer treatment.

Dr. Adam Mamelak is a board-certified dermatologist with extensive training and experience in Mohs micrographic surgery. At The Austin Mohs Surgery Center, he has helped numerous men and women overcome their skin cancer diagnosis, effectively removing the malignant tumors with high-quality results and an incredibly low recurrence rate.

Do I Need Mohs Surgery?

Mohs surgery is most often performed on squamous cell carcinomas and basal cell carcinomas, but some melanomas and other skin cancer types may be treated as well. Cases that may warrant Mohs typically exhibit one or more of the following:

  • Aggressive growth that is difficult to treat
  • Large in size, often with indistinct borders
  • Located in an area with thin tissue underneath, such as the face, genitals, hands, or feet
  • Previously treated with radiation and have recurred

In addition, the Mohs procedure can be the ideal solution for patients with certain genetic diseases or are immunosuppressed.

What Does the Mohs Procedure Involve?

Before Mohs micrographic surgery, the site will be numbed with a local anesthetic. Dr. Mamelak will then remove the visible tumor along with a small margin of the surrounding skin. This tissue is taken to our on-site laboratory, where it is examined under a microscope. Special ink is used to identify if the cancerous cells extend to the edges of the tissue. If they do, another layer of skin is removed from the area to be evaluated.

This process will continue until no cancer cells are found at the edges of the tissue sample. Following the skin cancer removal, reconstruction will be performed on the area to ensure minimal scarring and the most cosmetic outcome. This can involve a simple stitching, stretching of the skin to cover the area, or in more severe cases, a skin graft taken from a healthy area.

Mohs surgery is an outpatient procedure that can be performed during one visit. Depending on the size of your tumor, it may be performed in a single stage or may take five or more. If your lesion can be removed within a single stage, your procedure should be relatively quick. If it takes several stages to process your skin layers, a bandage will be temporarily placed over the site, and you can relax while you wait for the next stage. Dr. Mamelak typically recommends patients bring a book or a friend to help them pass the time between potential stages. Immediately after surgery, you can return home.

Will I Be Put to Sleep for My Mohs Surgery?

As a minimally invasive skin cancer procedure, Mohs surgery does not require patients to receive general anesthesia. The surgical site will be numbed with a local anesthetic, which ensures the patient feels minimal discomfort during their procedure. While the idea of surgery may be intimidating for many people, Dr. Mamelak finds that general anesthesia adds unnecessary risks to the patient, when numbing the site offers more than enough comfort. Since they are not put to sleep, Mohs patients can return home the same day.

How Long Does Mohs Surgery Take?

Mohs surgery can take anywhere from 20 minutes to over an hour to complete, but the actual cancer removal process may only take five to 10 minutes. This is because most of the Mohs procedure is spent evaluating the superficial layers of skin to find the border of the cancerous cells under the microscope. The total time it takes for your surgery will ultimately depend on the complexity of the tumor, the number of sections to evaluate, and possible special stains needed to highlight the cancerous cells.

What Can I Expect in My Mohs Surgery Recovery?

Patients typically need little to no downtime after their Mohs surgery, though certain precautions will need to be taken to ensure proper wound healing. Mild to moderate pain may be experienced in the first couple days, which can usually be managed with ice packs and over-the-counter pain medications. It is normal to have some degree of redness, swelling, and oozing around the surgical site, but this should gradually subside within the first few days to a week.

If your skin cancer was in a delicate area, such as near the eyes, you may experience more swelling and bruising, as well as temporary vision problems and headaches. These side effects tend to quickly disappear, with residual bruising lasting about one to two weeks. While slight oozing after Mohs surgery is common, actual bleeding is rare. Certain cases may require the patient to temporarily limit their activity and avoid exercising to prevent opening the wound and causing additional bleeding.

Infection after Mohs surgery is a rare complication, with studies showing this happening in only 1-2% of surgeries. Possible signs of infection include redness and swelling not going away, pus coming out of the wound, and prolonged or worsening pain after the first four days. If you experience any of these infection symptoms, please contact us immediately.

The stitches used to close the wound during Mohs surgery are typically left in place for one to two weeks. If possible, bandages should be placed over the surgical site while the sutures are in place. Patients should return within two weeks to have their stitches removed and have their wound examined.

What Does MOHS Stand For?

Many people think Mohs is an acronym, but it is actually named after the inventor of this surgical technique, Dr. Frederic Mohs (1910-2002). While at the University of Wisconsin – Madison, Dr. Mohs began developing this microsurgery technique, treating his first human patient in 1936. The surgery was officially developed two years later. Dr. Mohs taught doctors from all over the world to use his skin cancer removal method, which was most readily adopted by dermatologists, who learn skin histology and pathology during residency training.

Is Mohs Surgery Covered by Insurance?

Mohs micrographic surgery is typically covered by most insurance providers, due to being a medical procedure and not cosmetic in nature. In some cases, patients may be responsible for paying a portion of their Mohs cost, such as those who have not yet met their deductible. Our team at The Austin Mohs Surgery Center strives to make every visit to our office run smoothly, which is why we attain the necessary insurance information prior to the patient’s appointment. This allows us to relay the financial details to each patient so they know what to expect ahead of time.

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