Skin Cancer
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Mohs micrographic surgery is one of the surgical methods for the treatment of skin cancer. Skin cancer is by far the most common malignant tumor in humans. More than 1.2 million
Americans are diagnosed with skin cancer each year. The most common types of skin cancers, basal cell carcinoma, squamous cell carcinoma, and melanoma, may often be treated with Mohs surgery. Mohs surgery is the state-of-the-art treatment for skin cancers where the Mohs surgeon acts as the surgeon, pathologist and reconstructive surgeon. It is named after the surgeon, Dr. Frederick Mohs, who pioneered this precise technique. Mohs surgery relies on the precision and accuracy of a microscope to identify and map out roots of the skin cancer to give the higher chance that the entire tumor will be removed, greater than any other type of treatment for skin cancers. Dermatology and Skin Cancer Center of New Mexico has three fellowship-trained Mohs surgeons: Drs. David A. Davis, Daniel A. Davis, and Michael B. Chang. Each of these physicians is an expert in their discipline and is boarded in both Dermatology and Mohs Micrographic Surgery Specialties. Combined, they have performed more than 70,000 procedures in their careers. Mohs micrographic surgery allows for the selective removal of the skin cancer with the preservation of as much of the surrounding normal tissue as possible. As a result, Mohs micrographic surgery is very useful for: 1) larger tumors, 2) tumors with a more infiltrated or "finger-like" growth pattern, 3) tumors with indistinct borders, 4) tumors near a vital functional or cosmetic structure such as the eyes or nose, 5) tumors previously treated and 6) tumors located in areas with higher chance to recur (nose, around the nose, ears, around the eyes, lips or around the lips, and temple areas). During the initial appointment, your dermatologic physician will evaluate your lesion and discuss the procedure with you. He will also discuss possible complications and risks that may occur, although serious complications are extremely rare. No surgeon or technique can guarantee a 100% chance of cure; however, in most circumstances, the chance of cure with Mohs surgery exceeds 97%. |
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The Procedure
The surgical area will be cleaned and draped with sterile towels. Your Mohs surgeon will then anesthetize the skin containing the cancer by a small local injection. Once the area is numb, he will remove the cancerous tissue where it will be evaluated in our office laboratory. While your tissue is processed for examination, your wound will be bandaged, and you will move to the waiting area. It may take up to one hour for the evaluation of the cells. If the microscopic examination of the removed tissue reveals tumor roots, we will go back to the procedure room, to precisely remove more tissue that will again be processed in the laboratory to make sure all cancerous cells have been excised.
The Mohs procedure is occasionally referred to as chemosurgery or Mohs chemosurgery since originally, chemicals were applied to the skin during the surgery. Chemicals are now rarely used, but the name chemosurgery may continue to be associated with the procedure.
The surgical area will be cleaned and draped with sterile towels. Your Mohs surgeon will then anesthetize the skin containing the cancer by a small local injection. Once the area is numb, he will remove the cancerous tissue where it will be evaluated in our office laboratory. While your tissue is processed for examination, your wound will be bandaged, and you will move to the waiting area. It may take up to one hour for the evaluation of the cells. If the microscopic examination of the removed tissue reveals tumor roots, we will go back to the procedure room, to precisely remove more tissue that will again be processed in the laboratory to make sure all cancerous cells have been excised.
The Mohs procedure is occasionally referred to as chemosurgery or Mohs chemosurgery since originally, chemicals were applied to the skin during the surgery. Chemicals are now rarely used, but the name chemosurgery may continue to be associated with the procedure.
Reconstruction
After the skin cancer has been completely removed, a decision is made on the best method for closing the wound created by the surgery. These methods include letting the wound heal by itself, closing the wound side-to-side with stitches, or closing the wound with a skin graft or flap. The best method is determined on an individual basis, by your fellowship-trained Mohs specialist with the Dermatology and Skin Cancer Center of New Mexico.
Most of the wound closures are performed in our office. However, other surgical specialists may be involved for their unique skill, if a tumor turns out to be much larger than initially anticipated. We individualize your treatment to achieve the best results. When the reconstruction is scheduled to be completed by other surgical specialties, that reconstruction may take place on the next day or two. There is no harm in delaying the reconstruction for several days.
After the skin cancer has been completely removed, a decision is made on the best method for closing the wound created by the surgery. These methods include letting the wound heal by itself, closing the wound side-to-side with stitches, or closing the wound with a skin graft or flap. The best method is determined on an individual basis, by your fellowship-trained Mohs specialist with the Dermatology and Skin Cancer Center of New Mexico.
Most of the wound closures are performed in our office. However, other surgical specialists may be involved for their unique skill, if a tumor turns out to be much larger than initially anticipated. We individualize your treatment to achieve the best results. When the reconstruction is scheduled to be completed by other surgical specialties, that reconstruction may take place on the next day or two. There is no harm in delaying the reconstruction for several days.
After Mohs Surgery
Your surgical wound will likely require care during the weeks following surgery and prior to removal of any stitches. Detailed written instruction will be provided. You should plan on wearing a bandage and avoiding strenuous activity for the days following surgery. Please do not leave for travels during the week following your surgery to ensure proper medical evaluation if any problems result. Most of our patients report minimal pain, most of which will respond to Tylenol®. An ice pack (or bag of frozen vegetables) may also help with pain and reduce swelling, especially around the eyes. You may experience a sensation of tightness across the area of surgery. Supplies needed for wound care include hydrogen peroxide, cotton swabs, petroleum jelly or Aquaphor® and often, a form of bandage.
Skin cancers frequently involve nerves and months may pass before your skin sensation returns to normal. In rare instances, some numbness may be permanent. You may also experience itching as your wound heals. Complete healing of the surgical scar takes place over a period greater than one year. Especially during the first few months, the scar site may feel thick, swollen or lumpy. Some redness is normal. This redness is due to the increased size and number of blood vessels in the area of surgery. The redness usually fades after several months. Gentle massage of the area (starting about one month after the surgery) will speed the healing and softening process.
You will be asked to return to our Albuquerque office in several weeks and to your referring physician afterwards to monitor the healing process and also to closely follow if the cancer should recur. Studies have shown that once you develop skin cancer, there is a strong possibility of developing another skin cancer in the future. If you notice any suspicious areas, it is best to check with your referring physician for a complete examination. You will be reminded to return to your dermatologist frequently for continued surveillance of your skin.
Your surgical wound will likely require care during the weeks following surgery and prior to removal of any stitches. Detailed written instruction will be provided. You should plan on wearing a bandage and avoiding strenuous activity for the days following surgery. Please do not leave for travels during the week following your surgery to ensure proper medical evaluation if any problems result. Most of our patients report minimal pain, most of which will respond to Tylenol®. An ice pack (or bag of frozen vegetables) may also help with pain and reduce swelling, especially around the eyes. You may experience a sensation of tightness across the area of surgery. Supplies needed for wound care include hydrogen peroxide, cotton swabs, petroleum jelly or Aquaphor® and often, a form of bandage.
Skin cancers frequently involve nerves and months may pass before your skin sensation returns to normal. In rare instances, some numbness may be permanent. You may also experience itching as your wound heals. Complete healing of the surgical scar takes place over a period greater than one year. Especially during the first few months, the scar site may feel thick, swollen or lumpy. Some redness is normal. This redness is due to the increased size and number of blood vessels in the area of surgery. The redness usually fades after several months. Gentle massage of the area (starting about one month after the surgery) will speed the healing and softening process.
You will be asked to return to our Albuquerque office in several weeks and to your referring physician afterwards to monitor the healing process and also to closely follow if the cancer should recur. Studies have shown that once you develop skin cancer, there is a strong possibility of developing another skin cancer in the future. If you notice any suspicious areas, it is best to check with your referring physician for a complete examination. You will be reminded to return to your dermatologist frequently for continued surveillance of your skin.
After a Mohs surgery procedure, most patients find the recovery process simple and easy thanks to the streamlined surgical approach that leaves surrounding tissue unharmed. Nonetheless, it's common for patients to wonder what they can expect after a Mohs skin cancer surgery. This video is intended to help you understand what to expect in the short and long term. To ensure that your skin cancer treatment is performed to the highest standards of quality and competency, be sure to choose an American College of Mohs Surgery (ACMS) fellowship-trained Mohs surgeon. Learn more at www.mohscollege.org.
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5120 Masthead St. NE
Albuquerque, NM 87109 Phone: 505.243.SKIN (7546) Fax: 505-243-7547 Hours: Monday-Friday 8am - 12pm 1pm - 5pm |
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