Mohs Surgery

What is Mohs Surgery? A Detailed Look at the Procedure

Mohs surgery is a highly specialized and precise surgical technique used to treat squamous cell carcinoma and basal cell carcinoma, the two most prevalent types of skin cancer. The procedure is typically performed under local anesthesia, making it a comfortable experience for patients while allowing them to remain awake during the surgery.

The process begins with the removal of the visible portion of the skin cancer. Once this initial layer is excised, the surgeon meticulously examines the tissue under a microscope, creating a detailed map of the surgical site to identify any remaining cancer cells. This step-by-step examination allows the surgeon to remove only the tissue that contains cancer, preserving as much healthy skin as possible.

The Mohs procedure is repeated in stages, with each subsequent layer of tissue removed and examined until no cancer cells remain. This method ensures that all cancerous cells are eliminated while sparing the surrounding healthy tissue, which is especially important in cosmetically sensitive areas such as the face, ears, and hands.

Because Mohs surgery combines the roles of surgeon and pathologist, it provides an unparalleled level of accuracy and effectiveness. The real-time microscopic analysis of tissue allows for immediate and complete removal of the cancer, reducing the need for additional treatments and minimizing the risk of recurrence.

Following the removal of all cancerous tissue, the surgeon may perform reconstructive surgery to repair the area and ensure the best possible aesthetic outcome. The entire process is conducted in a single visit, making it convenient for patients while delivering the highest level of care.

At Dermatology Affiliates, our Mohs surgeons are highly trained in this advanced technique, bringing together surgical precision, pathological expertise, and reconstructive skill. This comprehensive approach is why Mohs surgery boasts the highest cure rate of all skin cancer treatments, with success rates nearing 99 percent.

Examples of Mohs Surgery

What is Mohs Surgery?

Mohs surgery is an advanced treatment procedure for skin cancer, that offers the highest potential for cure – even if the skin cancer has been previously treated. This procedure is a state-of-the-art treatment in which the physician serves as surgeon, pathologist, and reconstructive surgeon. It relies on the accuracy of a microscope to trace and ensure the removal of skin cancer down to its roots.

This technique allows dermatologists, trained in Mohs surgery, to see beyond the visible disease, and to precisely identify and remove the entire tumor, leaving healthy tissue unharmed.

This procedure is most often used in treating three of the most common forms of skin cancer: melanoma, basal cell carcinoma and squamous cell carcinoma.

What are the Benefits of Mohs?

The cure rate for Mohs surgery is the highest of all treatments for skin cancer — up to 99 percent even if other forms of treatment have failed. This procedure, the most precise method of tumor removal, minimizes the chance of cancer regrowth and lessens the potential for scarring and disfigurement.

Mohs Surgery in Atlanta, GA: Dermatology Affiliates

According to statistics reported by the American College of Mohs Surgery, “Mohs micrographic surgery has the highest cure rate of all treatments for basal cell and squamous cell skin cancers” with a cure rate exceeding 99 percent for new skin cancers and 95 percent for recurrent skin cancers.”

At Dermatology Affiliates, our Mohs surgeons are board-certified and specialize exclusively in Mohs surgery and related dermatological procedures. This focused practice allows them to refine their skills and stay updated on the latest advancements in the field.

Our patient promise is dedicated to your care. Our Mohs surgeons undergo extensive training beyond medical school and residency to ensure you receive comprehensive skin cancer care.

Mohs Surgery FAQs

Mohs surgery is highly effective, with cure rates of up to 99% for basal cell carcinoma and squamous cell carcinoma when performed in the early stages. Its precision in removing cancerous cells while sparing healthy tissue makes it one of the most successful treatments for skin cancer.

No. Mohs surgery is performed in a pleasant outpatient surgical suite and you may return home the same day. Hospital facilities are available if necessary.

The duration of Mohs surgery varies depending on the size and complexity of the cancer. On average, the procedure can take several hours, as each layer of tissue must be carefully removed, processed, and examined under a microscope before proceeding to the next layer. Patients should plan to spend the majority of the day at our clinic.

Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we may choose (1) to leave the wound to heal itself, (2) to repair the wound with stitches, or (3) to reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result.

Will I need to come back? Usually one return visit is all that is needed to examine the healed surgical site or to remove your surgical dressings. Afterwards, you may return to your referring physician for routine check-ups. Lifetime annual check ups are considered essential. After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your physician at least once each year for four years, not only to examine the treated skin cancer, but also to check for new skin cancers.

The most effective way to protect yourself from skin cancer is to avoid the harmful ultraviolet (UV) rays from the sun. Even if you tan easily, sun exposure can contribute to skin cancer in two significant ways. Firstly, sunlight can damage the genes that regulate cell growth, and secondly, it can weaken the immune system, allowing early-stage cancers to develop unchecked by the body’s normal defenses.

To minimize your risk:

Apply sunscreen with an SPF of at least 30, ideally with UVA/UVB protection, whenever you’re in the sun.
Limit sun exposure during peak hours, typically from 10:00 am to 4:00 pm.
Remember that UV rays can penetrate clouds, so protect your skin even on cloudy days.

By following these guidelines, you can enjoy outdoor activities without significantly altering your lifestyle or risking skin cancer.

From our QualDerm Family of Brands: Mohs Surgery for Skin Cancer

What to Expect at Your During Your Mohs Procedure

The Mohs process includes a specific sequence of surgery and pathological investigation. Mohs surgeons examine the removed tissue for evidence of extended cancer roots. Once the visible tumor is removed, Mohs surgeons trace the paths of the tumor using a map of the excised tissue and a microscope.

Once the obvious tumor is removed, Mohs surgeons:

remove an additional, thin layer of tissue from the tumor site.
create a “map” or drawing of the removed tissue to be used as a guide to the precise location of any remaining cancer cells.
microscopically examine the removed tissue thoroughly to check for evidence of remaining cancer cells.

If any of the sections contain cancer cells, Mohs surgeons:

return to the specific area of the residual tumor indicated by the map
remove another thin layer of tissue only from the specific area(s) where cancer cells were detected
microscopically examine the newly removed tissue for additional cancer cells

If microscopic analysis still shows evidence of disease, the process continues layer-by-layer until the cancer is completely gone. Selective removal of only diseased tissue using Mohs Surgery allows the preservation of much of the surrounding normal tissue. This systematic microscopic search reveals the roots of the skin cancer which is why Mohs surgery offers the highest chance possible for complete removal of the cancer while sparing the normal tissue. Cure rates exceed 99 percent for new cancers and 95 percent for recurrent cancers.

How to Prepare for Mohs Surgery

On the morning of your surgery, please shower and wash your hair to reduce the risk of surgical site infection. Have your normal breakfast unless specified otherwise. Upon arrival, complete a medical history form, bringing a list of medications. Discontinue Erectile Dysfunction medication 72 hours before surgery, and aspirin, ibuprofen, or herbal supplements 10 days prior if not medically advised. Alcohol should be avoided 48 hours before surgery. Refrain from makeup, perfume, nail polish, and jewelry. Arrange transportation, as a mild sedative may be administered. Nursing home patients must bring a companion for assistance.

These are general recommendations. We recommend working closely with your specific provider to plan and prepare for your Mohs surgery.

Planning for Recovery after Mohs Surgery

After undergoing Mohs surgery, patients need to plan for a smooth recovery.

Firstly, arrange for someone to drive you home after the procedure, as you may feel groggy from any anesthesia used.
Plan to take it easy for a day or two, avoiding strenuous activities.
And, follow your surgeon's post-operative care instructions diligently, which may include keeping the wound clean and dry.

Usually, one return visit is all that is needed to examine the healed surgical site or to remove your surgical dressings. Afterward, you may return to your referring physician for routine check-ups. Lifetime annual skin exams and dermatological checkups are considered essential.

After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your referring dermatologist at least once a year for four years not only to examine the treated skin cancer but also to check for new skin cancers.

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