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Mohs Surgery: What You Need to Know

Mohs Micrographic Surgery remains the most effective method of removing non-melanoma skin cancer available anywhere in the world today.

Mohs Micrographic Surgery is an advanced treatment process for skin cancer that offers the highest possible cure rate for many skin cancers and simultaneously minimizes the sacrifice of normal tissue. This cutting-edge treatment requires highly specialized physicians that serve as surgeon, pathologist, and reconstructive surgeon.

Watch our very own Dr. Leonard Y. Kerwin, M.D. discussing Mohs surgery in a recent episode of Gracefully Greying.

Among other forms of cancer, Mohs surgery can be used to treat:

  • Basal Cell Cancer
  • Squamous Cell Cancer
  • Sebaceous Carcinoma
  • Extramammary Paget’s Disease
  • Dermatofibrosarcoma Protuberans

The microscopic analysis of resected tissue allows the surgeon to track the removal of the cancer and ensure the complete elimination of all tumor roots. As tumors often extend below intact normal skin (like the roots of a tree), this procedure allows the surgeon to see beyond the visible tumor to ensure its complete removal.

The technique is most often used to remove the two most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma.

The cure rates for Mohs Micrographic Surgery approach 99% for most primary (untreated) cancers with a slightly lower cure rate for secondary or recurrent (previously treated) cancers. Because the surgery minimizes the amount of tissue removed, it provides us with the opportunity to optimize cosmetics and reduce scarring and the size of the defect.

Our doctors are highly respected in the industry for their caring, compassionate, and effective methods of treating cancer patients before, during, and after Mohs surgery. They have performed thousands of Mohs procedures, while also performing same-day aesthetic repair on over 99 percent of these cases. You can be confident in our talented and highly trained surgeons’ ability to achieve excellent results.

The Center for Skin Surgery is located at our Novi location. Dr. Aaron Cetner, Dr. Leonard Kerwin, and our newest doctor, Dr. Lindsay Sklar, are Board Certified Dermatologists and have completed fellowships in Mohs surgery.

Why Mohs

There are many available therapies for skin cancer. In many cases, treatments such as freezing, burning, radiation, or simple excision are appropriate. However, for tumors that are aggressive or located in cosmetically sensitive areas, these treatment methods may not be successful, as they rely on the naked eye to determine how much of the skin is affected. This may increase the chance of recurrence or cause unnecessary scarring.

With Mohs surgery, your surgeon removes the visible tumor with a small margin (called a “stage” or “layer”) and then examines this tissue under a microscope to map out the extent of the cancer. If the tumor remains, this process is repeated until the physician is ensured that all of the cancer is removed. This process of mapping out the “roots” of the cancer minimizes the risk of the cancer recurring, spares healthy tissue, and leaves as little scarring as possible.

Mohs surgery is indicated for basal and squamous cell carcinomas in certain situations, including:

  • Cancers located in cosmetically sensitive areas of the face, ears, neck, and scalp
  • Cancers located in areas where sparing normal tissue is critical, such as the hands, feet, or lower legs
  • Cancers that are large, aggressive, or growing rapidly
  • Cancers where the borders are difficult to define with the naked eye
  • Cancers that have come back after previous treatment

Preparing for Your Mohs Surgery

Mohs surgery is performed on an outpatient basis under local anesthesia. You will not have to go to the hospital and will not be “put under” with general anesthesia. Each “layer” or “stage” of Mohs surgery can require up to an hour for the sampling, processing, and examining of the tissue. The length of your surgery can therefore range from a few hours to the entire day, depending on the ultimate size and complexity of your skin cancer. Reconstruction typically takes place immediately following clearance of the tumor, after which you will be able to go home.

It is important to prepare properly for your Mohs surgery. We recommend eating breakfast and taking all of your regular medications the morning of surgery. Unless directed by your physician, please do not take aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve), Vitamin E, or Gingko Biloba for one week prior to surgery, as they may increase the risk of bleeding. Alcohol may similarly increase the bleeding risk, and should be stopped one week prior to and after surgery. Cigarette smoking can impair healing, and should be stopped or significantly reduced for at least one week prior to and after surgery.

What to Expect after Mohs Surgery

After your cancer has been completely removed, your doctor will determine the best method to repair the wound. Wounds are occasionally allowed to heal on their own, but more often are repaired with stitches. This may be done in a simple straight-line fashion, or may require a skin flap or skin graft.

All wounds are initially dressed with a bulky pressure bandage that must be kept dry and intact for two days. Thereafter, once-daily wound care is continued until the stitches are removed (usually 7 to 14 days after surgery).

Your physical activity will be limited for at least a week after surgery (and up to two weeks for some surgical sites). Activities such as heavy lifting, running, and working out must be avoided. Please make appropriate arrangements for work.

Most patients have minimal discomfort after surgery, and we recommend over-the-counter Tylenol (acetaminophen) or occasionally ibuprofen for pain.

Swelling and bruising are variable depending on the individual and surgical site. If surgery is done in close proximity to the eyes, lower forehead, or upper nose, some bruising and swollen eyelids should be anticipated.

There will be a scar at the site where the cancer is removed. The scar begins to heal in 1 to 3 weeks, but continued healing and improvement in the appearance of the scar occurs over the first 6 months. While the size of the scar will depend on the extent of the cancer, every effort is made to make the surgical site as inconspicuous as possible.