Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. Mohs surgery is also known as Mohs micrographic surgery.
The goal of Mohs surgery is to remove as much of the skin cancer as possible, while doing minimal damage to surrounding healthy tissue. Mohs surgery is usually done on an outpatient basis using a local anesthetic.
Mohs surgery is an improvement to standard surgery (local excision), which involves removing the visible cancer and a small margin of surrounding healthy tissue all at once. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery. This increases the chance of a cure and reduces the need for additional treatments or additional surgery.
Mohs surgery is used to treat the most common skin cancers, basal cell carcinoma and squamous cell carcinoma, as well as some kinds of melanoma and other more unusual skin cancers.
Mohs surgery is especially useful for skin cancers that:
As with any surgical procedure, Mohs surgery carries the risk of:
Other complications that may result from Mohs surgery are uncommon but may include:
Mohs surgery can be technically challenging. Many skin doctors (dermatologists) can perform Mohs surgery, since dermatologists learn about Mohs surgery in their medical training. Some Mohs surgeons have undergone specialized training — called a fellowship — to learn more about the procedure and become more proficient in Mohs surgery.
Ask your doctor about his or her qualifications and experience performing Mohs surgery.
Your surgeon may recommend ways you can prepare for your surgery. You may be asked to:
Mohs surgery is done on an outpatient basis in an operating room or procedure room that has a nearby laboratory that allows the surgeon to examine the tissue after it's removed.
In most cases, the procedure lasts a few hours. But since it can be difficult to tell how extensive a skin tumor is just by looking at its surface, doctors often advise reserving the whole day for the procedure.
You likely won't have to change into a surgical gown unless the location of the tumor requires it. To prepare you for surgery, your surgeon or a nurse cleanses the area to be operated on, outlines it with a special pen and injects the area with a local anesthetic. The anesthetic numbs the skin, so you won't feel any discomfort during the procedure.
Once the anesthetic has taken effect, your surgeon uses a scalpel to remove the visible portion of the cancer along with a thin, underlying layer of tissue that's slightly larger than the visible tumor. A temporary bandage is placed on your incision. This takes only a few minutes.
The surgeon then takes this tissue to the laboratory for analysis. This portion of the procedure typically takes the longest amount of time.
Expect to wait about an hour or so in a waiting room for the surgeon to return. It may help to bring a book or magazine to pass the time. You'll be able to use the restroom or have a snack, if you need to, but you won't be able to leave the surgeon's office until the procedure is complete.
While you're waiting, the surgeon or technician cuts the tissue sample into sections and examines them with a microscope. Your surgeon takes great care to keep track of the exact spot where each piece of tissue was removed by making a map. That way, if a small area of cancer is found in one piece of tissue, the surgeon knows precisely where to continue with the surgery.
If cancer remains, your Mohs surgery will continue. Your surgeon removes an additional layer of tissue from the affected area, taking care to remove tissue that contains cancer while leaving as much healthy tissue as possible intact. Again, you'll wait while the surgeon examines the tissue in the laboratory.
The process is repeated until the last tissue sample removed is cancer-free. Local anesthetic can be re-administered as necessary.
After all of the cancer has been removed, you and your surgeon can decide on how to repair the wound. Depending on the extent of the operation, this might include:
If the surgical area is extensive or complex, your surgeon may temporarily close your wound and then refer you to another surgeon for reconstructive surgery to repair the wound.
One of the advantages of Mohs surgery is that you know your results right away, and you usually don't leave your appointment until all of the skin cancer has been removed. You may have a follow-up visit with your surgeon or referring doctor to monitor your recovery to make sure your wound is healing properly.
Though Mohs surgery has a high rate of cure for skin cancer, you will always have a small risk of cancer recurrence or of developing another skin cancer.
People who have been diagnosed with skin cancer have an increased risk of developing skin cancer again, compared with people who have never had skin cancer. As many as half the people diagnosed with the most common types of skin cancer will develop another skin cancer again within five years.
Plan to undergo regular follow-up visits with your dermatologist or family doctor to spot any new skin cancer. Ask your dermatologist to create a follow-up schedule for you. How often you'll undergo follow-up skin exams depends on your diagnosis. Expect to have skin exams at least once or twice a year, and more often if your cancer was aggressive or is more likely to recur.