Mohs surgery is a safe and effective treatment for skin cancer, designed to remove thin layers of cancerous tissue until all of a malignant lesion is eradicated. What differentiates Mohs surgery from other dermatological cancer surgeries is that the microscopic examination on each layer of tissue is performed while the patient remains in the doctor’s office, so that more cancerous tissue can be removed if necessary. The procedure not only ensures that you leave the doctor’s office cancer-free, but that as much of your healthy tissue is preserved as possible. Mohs surgery has a 99 percent success rate in eliminating malignant tissue.
Reasons for Mohs Surgery
Mohs surgery is primarily performed to treat basal and squamous cell carcinomas, the two most common varieties of skin cancer, though at times, it is also used for melanoma.
Mohs surgery is useful in these areas, where preservation of healthy tissue is especially important.
Advantages of Mohs Surgery
- Exceptionally high rate of cure for primary (almost 100%) and recurrent (more than 95%) cancer lesions compared to other methods such as surgical excision, radiation, curettage and desiccation, and topical medications
- Immediate assurance that the cancer has been completely removed
- Convenience and safety of being performed under local anesthesia
- Only mild discomfort
- Maximum amount of healthy tissue left intact
- Less scarring than most skin surgeries
After a Mohs procedure, most patients can quickly resume normal activities, though they will have to protect the affected area. Any residual discomfort is easily treated with over-the-counter analgesics.
Preparation for Mohs Surgery
Patients, like their doctors, must prepare for Mohs surgery. We instruct our patients to prepare for Mohs surgery as follows:
- Don’t take any aspirin, ibuprofen, or vitamins for 1 week prior to surgery
- Continue taking prescribed anticoagulants, such as Coumadin or Wafarin
- Don’t drink alcohol for 24 hours prior to surgery
- Eat breakfast and take all prescribed medications on the day of surgery
- Bring a book to occupy yourself during downtime
- Bring someone for companionship and to drive you home
If you’re unable to keep your appointment for any reason, please remember to cancel your Mohs surgery at least 2 days in advance.
The Mohs Surgery Procedure
Mohs surgery is performed outpatient in Dr. Ragi’s office. It may be performed by a team of highly trained Mohs Surgeons (Dr. Ragi, Dr. Lu, and Dr. Lombardi). First, the treatment site is numbed with a local anesthetic. Then, thin layers of skin are removed, and each layer is examined microscopically to see if it contains malignant cells. Excision continues episodically until the cancer is completely removed, at which point the site is stitched closed.
Most Mohs procedures can be performed in three or fewer stages, and usually take between 3 and 4 hours. The length of the procedure depends on the size of the cancer. Most of your time will be spent waiting while tissue is microscopically examined. This is why it’s advisable for you to bring a book or a companion to help you pass the time during the intervals between excisions. If your surgery keeps you in our offices during the lunch hour, we’re happy to provide you with pizza and beverages.
Recovery from Mohs Surgery
After Mohs surgery, you may experience mild discomfort, bleeding, bruising, swelling, or itching. Pain medication is prescribed if needed, although most patients require only over-the-counter analgesics. Your surgical stitches will remain in place for 1 to 3 weeks, at which point you’ll return to our offices to have them removed.
We’re committed to giving you results that will please you, both aesthetically and medically. Every effort will be made to eliminate as much scarring as possible, even when reconstructive procedures, such as skin flaps or grafts, are necessary. Our surgeons typically hide stitches in the skin’s natural creases, or in out-of-sight areas, to camouflage any unavoidable scars.
Risks of Mohs Surgery
While Mohs surgery is considered to be extremely safe, there are risks involved in any surgical procedure. In the case of Mohs surgery, these risks, may include:
- Bleeding from the wound
- Infection at the site
- Hematoma (bleeding into the wound)
- Development of a keloid (enlarged scar)
Complications of Mohs surgery are quite rare. Our concerned involvement helps to ensure that your experience with Mohs surgery will be a positive one.
Mohs Micrographic Surgery
What is Mohs micrographic surgery?
- Mohs micrographic surgery is the most effective treatment for skin cancer, with a 99.9% cure rate. Unlike other methods, Mohs surgery allows a fellowship trained dermatologist to microscopically examine 100% of the skin removed. This allows patients to leave the office reassured that they are free of any skin cancer.
In addition to the highest cure rate for skin cancer, patients benefit from this tissue sparing technique, assuring the least amount of tissue is removed.
Dr. Ragi, who was trained by Dr. Fredrick Mohs, has performed over 20,000 Mohs surgery cases. All of our Mohs surgeons have completed an American College of Mohs Surgery approved fellowship, the highest level of qualification.
How long will I be at the office?
- Please allow at least 3 hours. Skin cancer is similar to a tree, although it may appear small above the skin, we cannot predict how deep it has spread within the skin. Because of Dr. Ragi’s dedication to removing the cancer and delicacy of the technique, the exact duration cannot be predicted. We will provide snacks while you wait in our spacious and comfortable waiting room.
Should I stop my blood thinners?
- Please stop aspirin 1 week prior to the surgery. Please continue all other medications, including Plavix, Warfarin (also known as Coumadin) or other blood thinners. If you have any further questions please discuss with your prescribing physician.
Can I drive myself home?
- Most patients are able to drive themselves home. Reasons patients may not be able to drive include if the cancer removal is performed near the eye.
Will I have general anesthesia?
- No. Mohs surgery is done with only local anesthesia, similar to what your dentist uses.
Will I have stitches?
- Generally, patients leave the day of their procedure with stitches, which are removed 1-2 weeks later in our office. Unfortunately, all surgical procedures carry the risk of scarring, and Mohs surgery is no different. Rarely, a specialized plastic/reconstructive surgeon performs the closure, normally at the behest of the patient. It is important to note that the size and location of the tumor heavily influence scarring potential.
Learn More About Mohs Surgery From:
- American College of Mohs Micrographic Surgery and Cutaneous Oncology