A specialized microscopically-guided surgery used to treat skin cancer
Mohs micrographic surgery (“Mohs Surgery”) is a highly-precise skin cancer treatment performed by a fellowship-trained surgeon who uses microscopic guidance. This technically-challenging surgery is primarily used to treat basal cell carcinoma and squamous cell carcinoma and can also be used to treat some types of melanoma and rarer skin cancers.
During the procedure, a surgeon removes the cancer layer-by-layer until no cancer remains. This ensures your surgeon can leave as much healthy tissue as possible intact. One of the advantages of Mohs surgery is that it allows for complete peripheral and deep surgical margin evaluation at the time of surgery, which offers patients the highest cure rate while minimizing the surgical defect.
Not everyone is eligible for this type of skin cancer surgery, but those with cancer on a sensitive area of the body, like the face, may benefit. For example, we commonly perform this surgery on the nose, neck, and hands. This procedure may also be advantageous in treating recurrent skin cancers or those that are aggressive.
What to expect
Mohs surgery is an outpatient procedure that is done under local anesthesia, which means the area will be numbed. Unlike other surgeries, you can continue eating and drinking up until the surgery.
On your procedure day, your surgeon will completely numb the tumor area with a local anesthetic. You'll be awake for the entire procedure, but you'll be comfortable. Then, they will remove a thin layer of the visible tumor, which they will analyze in the lab. Once the first layer is removed, your surgeon will bandage your wound as you wait for your surgeon to examine the removed layer of skin under the microscope.
This process takes time, as your surgeon will divide the tissue into sections and meticulously create microscope slides. This allows them to examine every edge of what was removed and determine whether or not they need to remove another layer of tissue. If any cancer cells remain within a layer, your surgeon will map out and remove the next layer only where it’s necessary until no further cancer is seen.
Once the cancer is removed, your wound will either be closed with stitches or bandaged and left open to heal. In some cases, your surgeon may need to use a skin graft or skin flap, taking skin from somewhere else in the body to close the wound. Mohs surgeons are specially trained to do this and may also coordinate the reconstructive surgery with other specialists, including plastic surgeons or hand surgeons, depending on the size and depth of the tissue removed.
We do recommend that you avoid other commitments on the day of surgery, as the length of your procedure may vary based on the size and complexity of the tumor. Because it is difficult to know how far skin cancers penetrate beyond the surface of the skin, we cannot always predict how many layers or stages it will take to remove it. However, you can rest assured that when you leave the appointment, your skin cancer will be completely removed. That's one of many advantages to this procedure. Consider bringing a good book or magazine, your phone, and anything else you may need to stay comfortable and engaged during your procedure.
Recovering from Mohs surgery and follow-up care
Your doctor will provide specific instructions for caring for your wound and scar to ensure the best cosmetic and functional result. We'll also recommend routine follow-up visits to screen for any new signs of skin cancer, as you have an increased risk of developing skin cancer again once you've had it. Some people will need skin exams annually, while others may need to get screened more frequently to ensure any recurring or new skin cancers are detected early.
Frequently asked questions
Should I get Mohs surgery?
Mohs surgery is a good option for treating some skin cancers, but it's not an appropriate option for everyone. We recommend discussing your case with your MedStar Health dermatologist or oncologist, as they'll recommend the best treatment for you based on:
The size of your skin cancer
The location of your skin cancer
How aggressive your cancer is
Your immune system status
...and other considerations.
In general, if you have a small cancer or it's located somewhere that is generally covered, like the back, Mohs surgery may not be appropriate. However, if cancer is located on a cosmetically sensitive area, like the head, neck, hands, feet, or genitalia, you may be a good candidate for this procedure.
How will my Mohs site be repaired?
This surgery involves removing layers of skin which can leave a scar or skin deficit. There are several ways we can repair the skin after surgery, including allowing the body to heal itself, closing the skin surgically, using a skin flap, or using a skin graft. Your repair will depend on the location of the tumor and the size and depth of the final wound. Your surgeon is trained in surgical reconstructive techniques and will discuss your options once the tumor has been removed. In some circumstances, we may work with other surgical colleagues to repair complex wounds to ensure the best possible functional and cosmetic outcome.
Do I need any imaging tests?
Most patients will not require any additional imaging tests prior to Mohs surgery, however, it is important to discuss your individual case with your provider.
Do I need any other treatments after Mohs surgery?
Most patients will not require any additional treatment, such as radiation or chemotherapy, after their procedure, but please discuss your unique case with your provider. We do recommend establishing routine skin exams with your dermatologist as you may as the risk of developing additional skin cancers increases if you have already had skin cancer.
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MedStar Georgetown Cancer Institute at MedStar Georgetown University Hospital
3800 Reservoir Rd. NW Washington, DC 20007
MedStar Georgetown Cancer Institute at MedStar Washington Hospital Center
110 Irving Street, NW Washington, D.C., 20010