Mohs Micrographic Surgery

There are many treatment options for cutaneous malignancies.  When used in the appropriate situations, Mohs Micrographic Surgery provides the highest cure rates while minimizing the amount of skin removed.  This ideally allows the smallest scar while achieving up to 98-99% cure rates.

The procedure involves removing skin cancers with a small margin of normal tissue surrounding the lesion.  The tissue is then processed in such a way that the entire margin is evaluated under the microscope.  This determines whether or not the skin cancer has been removed.  If the cancer has been removed, then the wound is then closed or it is allowed to heal on its own.  If there is still skin cancer remaining, then further skin is removed in the area(s) where the cancer remains.  This allows small and focal areas to be removed in staged excisions.  Thus preserving as much normal skin as possible.   This process is done all in the same day.  Each time a piece of skin is taken and processed may take up to 2 hours. Thus, one must expect to be in the office for at least the entire morning.

Some things to keep in mind if you have been scheduled for Mohs Micrographic Surgery….

1. The day of the surgery…

– Be sure to eat breakfast and take any medications that you normally take (unless you have been advised otherwise)

– Be prepared to be in the office for many hours.  Bring paperwork, books, snacks etc.  Expect to be bored.  We have no way to be sure how large a skin cancer will be until the lesion is removed and looked at under the microscope.  Most cases are cleared in 1 -2 stages but every lesion has the potential to spread farther microscopically than one can appreciate with their eyes alone.

2. Blood thinners

– If you take any blood thinners that have not been prescribed by your doctor we prefer that they be held 1 week prior to the procedure.  This includes aspirin, ibuprofen, NSAIDS, fish oils, Vitamin E, garlic supplements and alcohol.  If you have been prescribed any blood thinners by your physician we prefer that you discuss holding these medications with your health care professional, and not stopping without their advice.  If these medications are medically necessary, then they should be continued.  In the case that you are on coumadin (warfarin), we would like to see a blood level (INR) done within 48 hours of the procedure.  The INR level should be less than 3.

4.  Smokers

– If you are a smoker you should quit smoking.  This impairs wound healing and increases the risk for wound infections as well as failure of skin grafts and flaps.  If you have trouble quitting, we prefer that you not smoke for 6 weeks before and after the surgery to optimize results and minimize scarring.

5.  Scarring

– Although Mohs Micrographic Surgery provides the highest cure rates and minimizes the amount of skin removed, it will leave a scar. There is no way to remove a skin cancer that does not leave some sort of scarring.  We make every effort to provide the nicest looking scars.  We also offer the option of seeing a plastic surgeon for closure of the wound following Mohs Micrographic Surgery.  If you would like to see a plastic surgeon following removal of the cancer, feel free to discuss this with Dr Morgan.

6. Driving home

– We advise all patients to have a driver.  Please plan accordingly or have a ride available.

7. Anesthesia

– This procedure is performed under local anesthesia (injection into the area with a numbing agent).  No general anesthesia or sedation is used in the office.

8. Location

– The surgery takes place in the office.  Once the lesion is removed you will return to the waiting area until it has been examined under the microscope.  If additional stages (pieces of skin) need to be taken then you will return to the procedure room for this.

 

If you have any questions you may contact us at any time.  Further information is available at the following links.