How Mohs Surgery Works: What Patients Should Know
If you have been diagnosed with certain types of skin cancer, your dermatologist may recommend Mohs surgery. This specialized surgical technique is designed to remove cancerous skin cells while preserving as much healthy surrounding tissue as possible.
Mohs surgery is commonly used to treat basal cell carcinoma and squamous cell carcinoma, particularly when skin cancer occurs in areas where preserving appearance and function is important, such as the face, nose, ears, eyelids, lips, and hands.
Understanding how Mohs surgery works can help you feel more prepared and confident before your procedure.
What Is Mohs Surgery?
Mohs surgery is a precise technique for removing certain skin cancers. Unlike traditional excision, where the surgeon typically removes the tumor along with a predetermined margin of surrounding skin, Mohs surgery examines the tissue under a microscope during the procedure.
The surgeon removes the visible skin cancer along with a very thin layer of surrounding tissue. That tissue is then processed and examined to determine whether cancer cells remain.
If cancer cells are still present, the surgeon identifies exactly where they are located and removes another thin layer from that specific area. This process continues until the surgical margins are clear.
Because the surgeon removes only tissue that contains cancer cells, Mohs surgery can help minimize the amount of healthy skin removed.
Why Is Mohs Surgery Used?
The primary goals of Mohs surgery are to completely remove the skin cancer while preserving healthy tissue.
Your dermatologist or Mohs surgeon may recommend Mohs surgery when the cancer:
- Is located in a cosmetically or functionally important area
- Has an increased risk of returning
- Has poorly defined borders
- Is relatively large
- Has certain aggressive characteristics
- Has returned after previous treatment
- Requires maximum preservation of surrounding healthy tissue
Mohs surgery is particularly valuable on areas such as the nose, ears, eyelids, lips, and other parts of the face where removing unnecessary tissue could result in a larger scar or affect function.
Step 1: The Area Is Numbed
Mohs surgery is generally performed using local anesthesia, meaning the area being treated is numbed while you remain awake.
The surgeon will carefully inject a local anesthetic around the skin cancer. Once the area is numb, you should not feel the surgical removal, although you may experience pressure or movement.
Step 2: The Visible Cancer Is Removed
Once the area is numb, the surgeon removes the visible portion of the skin cancer along with a thin layer of surrounding tissue.
Rather than immediately removing a large amount of surrounding skin, the Mohs technique allows the surgeon to work in carefully controlled stages.
The tissue is then prepared for microscopic examination.
Step 3: The Tissue Is Examined Under a Microscope
This is the key feature that makes Mohs surgery different from many other skin cancer removal techniques.
The removed tissue is examined under a microscope to determine whether cancer cells remain at the edges, or margins, of the specimen.
The surgeon maps the tissue so that if cancer cells are identified, their precise location can be determined.
This allows the surgeon to target additional cancerous tissue instead of removing healthy tissue unnecessarily.
Step 4: Additional Tissue Is Removed if Necessary
If cancer cells are found in the margins, the surgeon returns to the specific area where cancer remains and removes another thin layer of tissue.
That layer is then examined again.
This process is repeated until no cancer cells remain in the examined margins.
Because the tissue is evaluated during the procedure, you generally remain at the office while the tissue is processed and examined.
Step 5: The Wound Is Repaired
Once the surgeon confirms that the skin cancer has been completely removed, the resulting wound can be evaluated and repaired.
Depending on the size and location of the wound, repair may involve:
- Allowing the wound to heal naturally
- Closing the wound with stitches
- Using a skin flap
- Using a skin graft
- Performing another reconstructive technique
Your surgeon will recommend the repair method that is most appropriate for your individual situation.
How Long Does Mohs Surgery Take?
Mohs surgery is usually performed as an outpatient procedure, but the amount of time you spend at the office can vary.
The surgical removal itself may be relatively quick, but each tissue layer must be prepared and examined before the surgeon knows whether another layer is necessary.
Some skin cancers can be removed in a single stage, while others may require several stages.
Because it is difficult to predict exactly how many stages will be necessary, patients should generally plan to spend several hours at the surgical office.
Is Mohs Surgery Painful?
Mohs surgery is performed under local anesthesia, so the treatment area should remain numb during the procedure.
You may feel pressure, pulling, or movement, but you should not experience significant pain during the removal.
After the procedure, you may experience some tenderness, swelling, bruising, or discomfort around the surgical site. Your surgical team will provide instructions for caring for the wound and managing discomfort.
What Happens After Mohs Surgery?
After the cancer has been completely removed and the wound has been repaired, your surgical team will provide instructions for wound care.
You may be instructed to:
- Keep the area clean
- Change dressings as directed
- Avoid strenuous activity for a period of time
- Watch for signs of infection
- Return for a follow-up appointment if necessary
- Protect the area from excessive sun exposure
Healing time varies depending on the size and location of the surgical site and how the wound was repaired.
What Are the Benefits of Mohs Surgery?
One of the major advantages of Mohs surgery is its combination of highly precise cancer removal and tissue preservation.
Potential benefits include:
- Careful examination of surgical margins
- Removal of cancerous tissue while preserving healthy skin
- Smaller surgical defects in appropriate cases
- High cure rates for many appropriately selected skin cancers
- Immediate microscopic evaluation of the removed tissue
- Particularly useful for skin cancers in sensitive or highly visible locations
However, Mohs surgery is not appropriate for every type of skin cancer. Your dermatologist or Mohs surgeon can determine whether it is the right treatment for you.
Choosing a Mohs Surgeon
If your dermatologist has recommended Mohs surgery, choosing an experienced and qualified Mohs surgeon is an important part of your care.
During your consultation, your surgeon can explain why Mohs surgery is being recommended, what to expect during the procedure, how the wound may be repaired, and what you can expect during recovery.
Protecting Your Skin After Treatment
Having skin cancer increases the importance of ongoing skin monitoring. Even after successful treatment, you should continue regular skin examinations and practice good sun protection.
Wear broad-spectrum sunscreen, seek shade when possible, wear protective clothing, and avoid indoor tanning.
Most importantly, contact your dermatologist if you notice a new or changing spot, a sore that does not heal, or any other concerning change in your skin.
Schedule a Skin Cancer Consultation
Mohs surgery is an advanced treatment option that can provide precise removal of certain skin cancers while helping preserve healthy surrounding tissue.
If you have been diagnosed with skin cancer or have been referred for Mohs surgery, a consultation with an experienced dermatologic surgeon can help you understand your treatment options and what to expect.
Contact Beacon Skin & Surgeries today to learn more about Mohs surgery and determine whether it may be appropriate for your skin cancer. We have locations in Allen Park MI, Livonia MI, Novi MI, Macomb MI, and Rochester Hills MI. You may also click here to schedule an appointment with us!
