Mohs surgery is a specialized procedure for the removal of skin cancers. Dr. Jennifer Hau is a board-certified dermatologist and fellowship-trained Mohs surgeon who performs Mohs surgery at Cypress Dermatology. In this procedure, the skin cancer is excised, oriented, and marked with dyes so that the relative positions of these sections can be identified under the microscope.
If the microscope exam reveals any residual tumor, its precise location will be identified and another layer of tissue will be removed from the patient at the corresponding site. This entire process is repeated until all the excised tissue is free of cancer cells. At this point, the surgical defect will be repaired with sutures.
Mohs Micrographic Surgery has a cure rate of 99% for most skin cancers and allows for the surgeon to remove the least amount of tissue from the patient while obtaining clear margins. This is especially important in cosmetically sensitive areas such as the face, ears, and neck, or more challenging healing areas including the scalp, legs, hands, and feet. Large skin cancers are also often treated with Mohs surgery.
Dr. Hau specializes in skin cancer surgery and if you are interested in having a known skin cancer treated at our office, please have your referring physician send us the referral Here. If you have a lesion you are concerned could be a skin cancer, please schedule a medical appointment with one of our dermatologists to have it examined.
- Depending on the location of your skin cancer, you may be able to wear your street clothes, or you may need to put on a hospital gown. The Mohs surgeon examines the spot where you had your biopsy and may mark it with a pen for reference. The doctor positions you for best access, which may mean sitting up or lying down. A surgical drape is placed over the area. If your skin cancer is on your face, that may mean you can’t see what’s happening, but the doctor talks you through it. The surgeon then injects a local anesthesia, which numbs the area completely. You stay awake throughout the procedure.
- Using a scalpel, the surgeon removes a thin layer of visible cancerous tissue. Some skin cancers may be “the tip of the iceberg,” meaning they have roots or extensions that aren’t visible from the surface. The lab analysis, which comes next, will determine that. Your wound is bandaged temporarily and you can relax while the lab work begins.
- The surgeon cuts the tissue into sections, color codes them with dyes and draws a map of the surgical site. In the lab, a technician freezes the divided tissue, then cuts very thin horizontal slices like a layer cake. The slices are placed on microscope slides, stained and covered. This meticulous process takes time.
- Using a microscope, the surgeon examines all the edges and underside of the tissue on the slides and, if any cancer cells remain, marks their location on the map. The physician then lets you know whether you need another layer of tissue removed.
- Back in the operating room, the surgeon injects more anesthesia if needed and removes another layer of skin, precisely where the cancer cells remain, based on the map. Then, while you wait, the lab work begins again. This entire process is repeated as many times as needed until there are no more cancer cells.
- Once the site is clear of all cancer cells, the wound may be left open to heal or the surgeon may close it with stitches. This depends on its size and location. 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. In some cases, your Mohs surgeon may coordinate the repair of your wound with another specialist such as a plastic surgeon, oculoplastic surgeon or hand surgeon. In most instances, however, the Mohs surgeon will repair the wound immediately after obtaining clear margins.
- If more than one or two rounds are needed, the entire process can take up to several hours, so be prepared for that. It’s worth it, though, because this precise technique has the highest cure rate of any treatment method and can save the greatest amount of healthy tissue, leaving the smallest scar possible. Carefully follow your doctor’s instructions for wound care, scar care and follow-up to achieve the best outcome.