Mohs Surgery at Florida Dermatology Specialists
Mohs surgery is an in-office surgery performed with local anesthetic. It is used for two main reasons--it is has the lowest rate of recurrence and it also leaves the smallest surgical wound to be repaired.
The area to be treated is injected with local anesthesia, like the when the biopsy was performed. The visible skin cancer is removed with a small margin and taken into the laboratory in the office. The tissue is processed in the lab on site. The doctor looks at the tissue under the microscope to see if there is any cancer left at the bottom or edges. If so, more tissue will be removed in a second layer, or stage, but only from those areas where there was still cancer remaining. This next section will also be analyzed in the lab. This process will be repeated until all cancer has been removed. It usually is one or two stages, or layers, but can sometimes require more.
Once the skin cancer has been removed, the doctor will review the options for healing. Most commonly, the wound is closed with stitches that same day. Most often, the wound is closed into a line of stitches. Sometimes, some nearby skin may need to be moved to help close the wound, which is called a skin flap. Other times, skin may need to be moved from a more distant site, which is a skin graft. The doctor can safely perform all these in the office. Sometimes, we allow the wound to heal on its own. It sometimes takes a long time to heal on its own, but may be a preferred option for some patients in some select circumstances.
Some patients may ask if they need to see a plastic surgeon. Your doctor is specially trained in Mohs surgery and reconstruction, trained through the American College of Mohs Surgery, and highly skilled and qualified to perform your surgery. If you would like, we would be happy to set up a consultation in the office to discuss this further.
Patients should plan on being in the office for up to three to four hours. It may rarely be longer.
Activity like vigorous exercise, tennis, or golf may be limited during that time until stitches come out. In addition, there can be no underwater submersion until the stitches have been removed. This means no swimming or baths until then. If there are special concerns or considerations, they can be reviewed on the day of surgery.
There will be a pressure bandage on the site. It can be removed 48 hours after surgery. There is often little required wound care after that. Showering will be fine after the pressure bandage has been removed, which is generally 48 hours after surgery.
The risks of the surgery are small, including bleeding, low risk of infection, 1-3% recurrence of the cancer, and a thin scar.
We recommend all Mohs patients to have a driver if the surgery will be performed on the face. There will likely be a bulky bandage on the area that may obstruct or partially obstruct vision for driving.
We recommend this site for further education and information:
The recurrence rate is 1-3%.
You will also need to review Preoperative Concerns and Protocols.