What is Mohs Surgery?

Mohs micrographic surgery is a type of skin cancer surgery that is most effective in removing most types of skin cancers such as basal cell carcinomas, squamous cell carcinomas and melanoma-in-situ. Mohs surgery is a tissue sparing procedure that offers the highest cure rate of skin cancer (up to 99%) and is superior to that of other treatment modalities. It offers maximal preservation of normal tissue and therefore the lowest functional and cosmetic morbidity. It has become the most reliable and cost-effective skin cancer treatment. Dr. Frederick Mohs first developed Mohs Micrographic Surgery in the 1930’s. It was initially named as chemosurgery because of the chemical interaction between zinc chloride and human tissue. The technique has been refined over the years to the point where the skin cancer is now removed and examined under the microscope for any remaining tumor real time. In the 1980’s the American College of Chemosurgery changed its name to the American College of Mohs Surgery (ACMS). Dr. Alexandra Zhang is a ACMS fellowship trained in Mohs Micrographic Surgery and Cutaneous Oncology.

Committed to outstanding care

Dr. Alexandra Zhang is an expert in skin cancer treatment. She achieved the highest degree of Mohs surgery qualification by completing an American College of Mohs Surgery approved fellowship. As a fellowship trained Mohs Surgeon, Dr. Zhang gained a specific level of exposure, including everything from challenging tumor locations to rare tumor pathology and complex wound reconstruction. When it comes to your skin cancer treatment, you deserve the best possible care. You can rest assured that Lucent Dermatology and Skin Surgery Center has the training and experience to achieve the best outcome from your skin cancer treatment.

Please watch the informative patient video at www.mohscollege.org.

What to expect: Day of Surgery

Your Mohs Surgeon will identify the biopsy site of the skin cancer and surgically remove the skin cancer with a conservative 1-2 mm margin, sparing the normal tissue.  After the removed tissue is graphically mapped, it is frozen, stained and cut for microscopic slides, then reviewed under the microscope to detect any residual tumor at the borders.  This process usually takes around 30 to 45 minutes to complete but can take longer with larger skin cancers. If any of the margins are positive for skin cancer, they are mapped and the Mohs surgeon then returns and removes only those areas where a residual skin cancer is involved.  This process is repeated until all of the margins are clear of the skin cancer, achieving a cure rate of 98-99%. Although some skin cancers are removed in only one stage, most require two or more stages to ensure complete removal of the tumor.

After your skin cancer has been cleared, your surgeon will decide on the best method to repair the wound.  Depending upon the location and size of the wound, it may be allowed to heal on its own, closed with sutures or repaired with a surgical flap or graft.  While most surgical wound are repaired on the day of surgery, sometimes it is necessary to arrange for reconstruction by other surgical specialties following your surgery.

On the day of your surgery:

• Eat a good breakfast
• Bring something to read
• Take your normal medications unless instructed otherwise
• Bring a snack or lunch with you
• Arrive 15 – 30 minutes early

What to expect: Day After Surgery

On the day of your surgery, you will receive detailed wound care instructions. Leave the bandage in place for the first 24-48 hours. Afterwards, clean the wound daily with a mild soap and water and cover it with a liberal amount of petrolatum or Aquaphor ointment and a clean dressing. This will be continued until the sutures are removed (usually for 7 to 14 days after the surgery or until they dissolve). It is very important to keep the wound moist with ointment and not to let it dry out. When a wound dries and a scab forms, it will take longer to heal and is more likely to form a more noticeable scar.

Most patients report some mild discomfort at the surgical site during the first day or two following surgery. This discomfort usually responds readily to Extra Strength Tylenol™.  Avoid taking aspirin, naproxen or ibuprofen containing products for three days following surgery as these medications increase your bleeding risk. Some minor, local bleeding is normal and expected post-surgery.

Sometimes patients have bruising and swelling around the surgery site. This reaction is a normal part of the healing process as the body repairs itself after surgery and then slowly begins to improve.

Patients may also experience numbness around the surgical site when small sensory nerves in the skin are cut during surgery; it may take 6-12 months before full sensation returns. Rarely, when a skin cancer involves larger nerves and these are cut, the loss of sensation or muscle weakness may be permanent.

Please keep in mind that every surgical procedure creates some form of scar. Although every attempt will be made to minimize and hide the scar, the extent of the scarring depends on the location, size and depth of the skin cancer and the healing properties of the individual.  Most scars will continue to remodel and improve over the first 6 to 18 months after surgery. Many techniques are available to improve the appearance of scars, so talk with your dermatologist if you not satisfied with its appearance.

Most of the time, sutures are removed at 7 to 14 days after surgery. After surgery, you should be monitored every 3 to 6 months for new skin cancers. Although there is only a 1 to 2 % risk of developing a recurrent skin cancer recur after Mohs surgery, it can happen and the area should be monitored. In addition, 50% of patients who have a skin cancer will develop another skin cancer at a different site within five years of their first. It is important to protect yourself from the sun’s rays and to have a dermatologist follow your skin closely. If you notice any new lesions and suspect they might be skin cancers, you should schedule a follow up appointment soon and not wait until the next scheduled visit.