What is Mohs Micrographic Surgery?

Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer. The procedure was developed in the 1930s by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all “roots” and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.

Advantages of the Mohs Surgical Procedure –

Some skin cancers can be deceptively large – far more extensive under the skin than they appear to be from the surface. These cancers may have “roots” in the skin, or along blood vessels, nerves, or cartilage. Skin cancers that have recurred following previous treatment may send out extensions deep under the scar tissue that has formed at the site. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous “roots.” For this reason, prior to Mohs surgery it is impossible to predict precisely how much skin will have to be removed. The final surgical defect could be only slightly larger than the initial skin cancer, but occasionally the removal of the deep “roots” of a skin cancer results in a sizable defect. The patient should bear in mind, however, that Mohs surgery removes only the cancerous tissue, while the normal tissue is spared.

The Mohs Surgery Procedure –

mohs graphicTypically, Mohs surgery is performed as an outpatient procedure in the physician’s office. Although the patient is awake during the entire procedure, discomfort is usually minimal and no greater than it would be for more routine skin cancer surgeries. The Mohs surgical procedure is illustrated in the diagram to the right. 

Insurance Coverage for Mohs Surgery – 

Most insurance policies cover the costs of Mohs surgery and the reconstruction of the resultant surgical defect. Please contact the billing department of your Mohs surgeon’s office if you have questions about insurance coverage or to see if your insurer requires you to have a referral from your primary care physician. You may need to contact your insurance company directly about benefits or coverage.

Patient Preparation for Surgery –

You should provide your physician with a complete list of all medications (prescription, over-the-counter, vitamins and supplements). This is especially true regarding blood thinners, including aspirin, aspirin substitutes, herbal medicines and supplements. Your doctor may have other preoperative instructions. Pay special attention to these. Additionally, Mohs surgery on some areas may impair your ability to safely operate a motor vehicle. Discuss this with your doctor or his representative before your surgery.

Duration of Procedure –

Most Mohs cases can be completed in three or fewer stages, requiring less than four hours. However, it is not possible to predict how extensive a cancer will be, as the extent of a skin cancer’s “roots” cannot be estimated in advance. Therefore, it is advisable to reserve the entire day for this surgical procedure, in case the removal of additional layers is required.

What to Know About Post-Surgery – 

Most patients do not comment about a significant amount of pain. If there is some discomfort, normally only Tylenol is needed for relief. However, stronger pain medications are available and may be prescribed sparingly when needed. You may experience bruising, swelling and small amounts of bleeding around the wound. If any of these are severe, you should contact your surgeon. Your activity will be restricted after surgery. Do not lift over 10 pounds the first week after surgery and do as little bending over or straining as possible. Avoid any long trips within the first 10 days following surgery in case complications develop. Post-surgical follow-up visits to inspect the surgical site and remove stitches will be needed and are usually scheduled about a week after surgery.