What is Mohs Surgery?
Mohs Micrographic Surgery is the most advanced and effective treatment for skin cancer available. Mohs Surgery provides the maximum potential for a cure, even if you have been previously treated by another method for your skin cancer. The Mohs Surgery technique allows Dr. Hodge to precisely isolate and excise the complete skin cancer while leaving the healthy surrounding tissue intact and undamaged. The Mohs Surgery option is often reserved for the treatment of tumors that have reoccurred following another treatment or for lesions in technically challenging locations such as your eyelid, nose or ear. What makes Mohs surgery so effective is the unique way excised tissue is microscopically examined while surgery is in progress, ensuring all surgical margins are clear prior to completing the procedure. The pathologic interpretation of your tissue is performed on site by Dr. Hodge who is specially trained to review the slides.
Some advantages of Mohs Surgery include:
- Complete skin cancer removal during the surgery, nearly eliminating the chance of your tumor coming back.
- Maintaining the maximum amount of intact and undamaged healthy tissue.
- Improved cosmetic and functional surgical outcomes as a result of minimizing wound size.
- Same day excision of the cancer and repair of the skin cancer site (in most cases).
- Providing a cure for your skin cancer where other methods may have failed.
The Mohs Surgery procedure allows Dr. Hodge to surgically remove the skin cancer very meticulously, leaving very small margins between healthy and diseased tissue. Dr. Hodge then examines the tissue under a microscope to determine if the margins are in fact clear in all directions. If any margin is suspect, the process is repeated until all margins are clear and Dr. Hodge is confident there is no more diseased tissue. In most cases, Dr. Hodge will be able to immediately surgically close the wound. Mohs surgery, like traditional skin cancer surgery, is considered a relatively minor outpatient office procedure and you should be able to return to work or home immediately following the surgery. All procedures are performed under local anesthesia.
In traditional skin cancer surgery, larger margins must be excised around the diseased tissue to provide confidence that the margins will be clear. In traditional skin cancer surgery, the wound is often kept open for a day or more while the tissue samples are prepared and examined under a microscope to insure that all margins are clear before closing the wound. The key element of Mohs surgery is the ability to process and interpret tissue samples on the spot in the doctor’s office while the patient waits to find out if additional tissue needs to be excised. Mohs surgery can only be performed by surgeons who are thoroughly trained in the microscopic interpretation of tissue samples.
Mohs surgery appointments are usually scheduled early in the day. Upon arrival, our staff will escort you into one of our procedure rooms and address any questions or concerns you may have. Dr. Hodge will apply an anesthetic to numb the area thoroughly. Once the area is fully anesthetized, the skin cancer will be precisely excised layer by layer, with each layer going to the onsite laboratory for review. During the time that the Mohs tech is preparing your tissue samples and Dr. Hodge is microscopically analyzing your tissue, a temporary dressing will be applied. Soon, Dr. Hodge will return to perform further excision or to execute a closure.
Excising each layer of tissue may take only 15-20 minutes; however, the total time between stages varies depending on processing and reviewing time. You will be asked to wait in the room, the waiting area or the kitchen enjoying coffee and a snack while the laboratory review is proceeding. If any remaining skin cancer is found at the margins, you will be brought back to the procedure room and another thin layer will be taken from the same area for review. Although there is no way to know in advance how many layers will need to be examined, most skin cancers are removed in three stages or less. The surgery often lasts the entire morning or even longer, so it’s best that you do not make any other commitments that day.
Our staff will arrange post-procedure visits following your Mohs surgery to monitor your recovery progress and spot any skin cancer recurrence (which is highly unlikely). As is true of any procedure to treat skin cancer, follow-up appointments are of extremely high importance to aid in the early detection of any new lesions. It is known that two out of five patients with one skin cancer will develop another within five years.
Mohs surgery is relatively time consuming and expensive. In many cases, the reduction in margin size made possible by Mohs surgery is not critical in terms of achieving an optimal functional and cosmetic surgical result. But in cases where minimizing the removal of tissue is critical or where recurrence is a particular threat or concern, Mohs surgery is often the best option. You can trust Dr. Hodge to provide you with options as well as a recommendation.