dermatologist exam

Skin cancer is the most common form of cancer in the U.S. and around the world. Even a small area of cancerous cells can be dangerous and require removal. But removing skin cancer can actually be fairly easy and painless and done in a single day.

The term “Mohs” is not an acronym or technical term. It’s the name of a surgeon who pioneered this effective technique of removing skin cancer, Dr. Frederic E. Mohs. Mohs surgery is an incredibly effective treatment and can be life-changing for some skin cancer patients. If you are affected by basal cell carcinomas or squamous cell carcinomas—the most common forms of skin cancer—Mohs surgery may be a great option.

Before you talk to your dermatologist about the surgery, here are 11 things to understand about how to know if Mohs surgery is right for you:


Moh’s surgery is a highly effective, targeted method of removing skin cancer


Mohs surgery is considered one of the best methods for removing skin cancer. Mohs surgery is typically used to treat basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), but it has also been used to remove melanoma. Mohs surgery can be used even on aggressive or oddly shaped BCCs and SCCs all over the body.

Common areas where Mohs surgery is performed include around the eyes, nose, lips, ears, scalp, fingers, toes, or genitals. Instead of cutting out a large section of skin that includes both cancerous and non-cancerous cells, Mohs surgery is a more targeted approach that only removes cancerous cells and maintains as many of the healthy cells as possible.

Mohs surgery is considered the most effective way for treating these skin cancer conditions.


Length of the procedure


Patients are treated in a clinic setting using local anesthesia and return home the same day. The idea of out-patient surgery for skin cancer is revolutionary, as other surgery methods were much more invasive.

In Mohs surgery, the goal is to slowly shave down and remove the cancerous skin cells instead of completely removing the cancerous cells all at once and also removing some healthy skin around it. The procedure is done in stages, all in one visit, while the patient waits between each stage. Because the procedure is done in stages, it allows for more accurate results without any lasting impacts or need to stay in the hospital overnight.

Mohs surgery typically takes a few hours, but the exact time depends on the lab results that happen during the procedure. If the cancerous cells aren’t completely removed in the first step, the procedure can take longer. When preparing for Mohs surgery, block out your entire day because the doctor can’t say exactly how long it will take.


When to consider Moh’s surgery


Before you can be recommended for Mohs surgery, a dermatologist will examine your skin and perform a biopsy to see if the skin is cancerous.

Many people detect skin cancer because they notice their skin looks different or their mole are changing shape or growing. Regular visits to your dermatologist are crucial to keeping an eye on your changing skin. After a dermatologist has performed a biopsy and discovered the area is cancerous, you will likely be recommended to a surgeon trained in Mohs surgery.

Most dermatologists can perform Mohs surgery, but you may be referred to a specialist who has additional Mohs training. Mohs surgery is especially useful for patients with skin cancer that has returned after a previous treatment, is located near sensitive areas that could lead to noticeable scars, or is oddly shaped and large.


Performing Moh’s surgery


The doctor starts by examining your skin. Before the procedure, the surgeon will look closely at the skin around the biopsy area and prepare you for surgery. In most cases, patients can stay in their street clothes instead of wearing a gown.

However, you may be asked to change or wear a cloth if the skin cancer is in a hard-to-reach area. The doctor will then apply local anesthesia, which numbs only the area of your skin receiving treatment while you stay awake and alert.

Localized anesthesia allows patients to talk to the surgeon and be aware of what is happening to their body without feeling the pain of the procedure.


Performing Moh’s surgery


The doctor then uses a scalpel to remove just the top layer of cancerous cells. After the skin layer has been removed, the doctor will place a temporary bandage on the wound. This process only takes a few minutes. The surgeon examines those under a microscope in an on-site lab. The skin cells are frozen, placed on slides, and examined under a microscope to see if they are cancerous. The doctor and lab technician work together to create a map of the skin cells so they can determine the exact location of the cancerous cells.

This process can take some time, and the patient typically waits in the office while it is done. Some skin cancers are much deeper than they appear from the surface, so even though the area may seem small, it can actually go quite deep into the skin. If any cancerous cells remain, the doctor repeats the process by removing the next layer of skin cells and examining them until no cancerous cells remain.

If needed, the doctor will apply more localized anesthesia before continuing. Because the process of examining and mapping the cancerous cells is so precise, the surgeon knows exactly where to
remove the cancerous cells and what areas to target.


Closing the wound


After the cancerous cells are removed, the wound is closed. Once the surgeon confirms that all cancer cells have been removed, the wound will normally be repaired using stitches. Smaller wounds may be left open to heal on their own without the added chance of scarring from stiches.

How the wound is closed depends on its size and location on the body. In some cases, a wound may need reconstruction with a skin flap, where neighboring tissue is moved into the wound, or possibly a skin graft ­– using skin from another part of the body. In those cases, the surgeon may confer with a plastic surgeon for a smoother recovery.

If that happens, the surgeon will likely temporarily close the wound to keep it clean and then refer you to another doctor. Those instances are rare, however, and in most cases, the Mohs surgeon will immediately close the wound.


Peace of mind


Mohs surgery has an impressive track record for removing skin cancer. The number one goal of surgery is complete removal of all cancerous cells. Medical research has demonstrated the cure rate of Mohs surgery to be 99% for skin cancers not previously treated.

Mohs surgery allows surgeons to confirm that all cancerous cells have been removed at the time of surgery instead of waiting until after surgery to check for remaining cancerous cells, which greatly increases the chance of curing a patient’s skin cancer without needing additional surgery or treatments.

Other types of skincare surgery don’t test for remaining cancer cells until the follow-up appointment, which means there is a chance that the cancer doesn’t get removed all at once and the patient has to return for another invasive surgery. That isn’t the case with Mohs surgery, so patients can move towards healing and getting back to normal life as quickly as possible.

It also gives patients peace of mind when they leave their surgery that all of the skin cancer has been removed.


After Moh’s surgery


Mohs surgery leaves the smallest scar possible. Some other methods of removing skin cancer leave behind noticeable scars, but Mohs surgery is known for healing more quickly and without leaving a large scar.

Because the surgery is targeted to only the cancerous cells, the affected area is usually quite small and can heal quickly and without leaving long-term scarring. Most patients experience some pain and swelling in the affected area for 24 hours after the surgery. In most cases, patients are recommended to limit their activities for two to seven days after surgery to allow the skin to properly heal.

It’s typically recommended to avoid exercise after Mohs surgery for about a week to avoid any bleeding or other issues. After Mohs surgery, makeup can be applied within a few weeks or once the wound has fully sealed. The stitch lines may be more visible while they are healing, but they can be concealed with makeup as long as the wound is no longer open.


Recovering from Moh’s surgery and follow up


After the surgery, the surgeon will bring you back for follow-up treatments. Most patients are asked to return for a checkup within one to two months of their surgery to make sure the wound is healing properly. They are also given at-home treatments for wound care and scar care. Following those instructions is crucial to minimizing the appearance of a scar and in keeping the wound safe and clean.

Although Mohs surgery is incredibly effective at removing skin cancer, there is always a chance that the cancer can come back. After having Mohs surgery, plan to regularly visit your dermatologist at least once a year for a checkup of your skin and to make sure there aren’t any other cancerous areas.


Cost of Moh’s surgery


Mohs surgery tends to be one of the most cost-effective treatments. Instead of having the cost of spending lots of time in the hospital, Mohs surgery is an out-patient surgery and comes with much lower hospital costs.

Mohs surgery also uses localized anesthesia instead of more expensive general anesthesia and on-site lab work instead of the cost of sending skin samples to an off-site lab. The exact cost of Mohs surgery varies depending on the doctor, skin cancer, and insurance, but in general, the procedure is much more cost-efficient than other alternatives.

Potential risks of Moh’s surgery


Mohs surgery comes with some minor risks. The procedure itself is considered quite safe, but as with any surgery, there are some risks. Mohs surgery could lead to bleeding, infection, or tenderness around the surgical site. However, these risks are minor, and in most cases are resolved fairly quickly.

Mohs surgery could also lead to complications including temporary numbness or weakness around the surgical area, itching, or an enlarged scar, but again, these complications are not common. Most patients have a smooth experience of having their skin cancer removed and their skin healing as expected.

 

Mohs surgery is a great option for many skin cancer patients. With a multitude of benefits, including an effective procedure with minimal scarring, Mohs surgery could be the right procedure for you. If you are diagnosed with skin cancer, talk with your dermatologist to see if Mohs surgery is the best treatment for you.

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