Home Home Services Before & After Photos Resources Contact Us Shop
General Information: Mohs Surgery

What is Mohs Surgery?
Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer. The procedure was developed in the 1930s by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all “roots” and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.

Advantages of the Mohs Surgical Procedure:
Some skin cancers can be deceptively large – far more extensive under the skin than they appear to be from the surface. These cancers may have “roots” in the skin, or along blood vessels, nerves, or cartilage. Skin cancers that have recurred following previous treatment may send out extensions deep under the scar tissue that has formed at the site. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous “roots.” For this reason, prior to Mohs surgery it is impossible to predict precisely how much skin will have to be removed. The final surgical defect could be only slightly larger than the initial skin cancer, but occasionally the removal of the deep “roots” of a skin cancer results in a sizeable defect. The patient should bear in mind, however, that Mohs surgery removes only the cancerous tissue, while the normal tissue is spared.

Insurance Coverage for Mohs Surgery:
Most insurance policies cover the costs of Mohs surgery and the reconstruction of the resultant surgical area. Please contact your insurance carrier directly for the most current payment information relative to this surgery. The insurance billing department in Dr. Lin’s office will be able to assist you. If you are taking prescription medications, continue to take these unless otherwise directed by a physician. However, you should inform Dr. Lin if you are taking blood-thinning medications such as coumadin, Plavix, aspirin, aspirin substitutes (such as Advil, Motrin, Nafton, Naprosyn, etc.),vitamin E, gingko, garlic, ginseng, ginger, ephedra or other nutritional supplements. These medications and supplements can sometimes cause an increased chance of bleeding after surgery. It is important that you obtain a good night’s rest and eat normally on the day of your surgery. For your comfort, it is recommended that you wear casual, layered clothing. You may also wish to bring a light snack and a book or magazine to help occupy your waiting time. Also, it may be advisable to arrange for someone to drive you home following surgery, if needed. Most Mohs cases can be completed in three or fewer stages,requiring less than four hours. However, it is not possible to predict how extensive a cancer will be, as the extent of a skin cancer’s “roots” cannot be estimated in advance. Therefore, it is advisable to reserve the entire day for this surgical procedure, incase the removal of additional layers is required.

Wound Healing, Scarring, and Scar Revision:
As with all forms of surgery, a scar will remain after the skin cancer is removed and the surgical area has completely healed. Mohs micrographic surgery, however, will leave one of the smallest possible surgical defects and resultant scars. Often, wounds allowed to heal on their own result in scars that are barely noticeable. Even following extensive surgery, results are frequently quite acceptable. In addition, scars do have the ability, through the body’s own natural healing properties, to remodel and improve in appearance for a six to twelve month period. There are also many other techniques available to the patient for enhancement of the surgical area following skin cancer surgery. Depressed or indented scars may be elevated, using an filler, such as Restylane. Likewise, a raised or roughened scar may be smoothed, using laser resurfacing or chemical peeling techniques. Skin flaps and grafts also may require a subsequent “touch up” procedure, to further improve their appearance.

Minor Post-Surgical Pain Expected:
Most patients do not complain of significant pain. If there is some discomfort, normally only Tylenol is required for relief. However, stronger pain medications are available and will be prescribed when needed. You may experience some bruising and swelling around the wound, especially if surgery is performed near the eye area.

Potential Complications Associated With Mohs Surgery :
Patients should understand that there is not an absolute guarantee that any given procedure will be totally free of complications or adverse reactions. Mohs surgery is no exception. During surgery, tiny nerve endings are cut, which may produce a temporary or permanent numbness in and around the surgical area. If a large tumor is removed or extensive surgery is required, occasionally a nerve to muscle may be cut, resulting in temporary or permanent weakness in a portion of the face. This is, however, an unusual complication. The surgical area may remain tender for several weeks or months after surgery, especially if large amounts of tissue were removed. Rarely, some patients experience intermittent itching or shooting pain in the surgical area. In addition, the skin grafts and flaps used to cover surgical areas may not fully survive, requiring additional repair.

Options for Post-Surgical Reconstruction:
After the skin cancer has been removed, Dr. Lin will discuss the following options with you:

• Allowing the wound to heal naturally, without the necessity of additional surgery (which may produce the best cosmetic result).

• Simple or complex wound repair performed by the Mohs surgeon.

• Referral to the original referring physician for wound repair.

• Referral to another surgeon for wound repair.

• If your wound requires daily care at home, you will be given detailed instructions following your surgery. For small post-surgical sites, direct closure by suturing the sides of the wound together may be possible. However, in certain areas of the body, there is very little tissue that can be stretched for coverage of a wound, and either a skin graft or skin flap must be used. In closing wounds with a skin flap, the skin adjacent to the surgical defect is partially cut free, and then rotated or moved forward to cover the surgical area. Stitches are then placed to hold the flap in its new position. This provides immediate coverage for the wound. Other areas may require a skin graft to provide coverage. Skin from the side of the neck, behind the ear, or over the collarbone may be cut free, placed over the wound, and then sewn into place. The original site of the graft is then closed with stitches or allowed to heal on its own.

ADSCI - Advanced Dermatology Skin Cancer Institute Linage Dermatology Linage Skin Care