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Mohs Surgery
 
More than one million Americans are diagnosed with some form of skin cancer every year. However, when detected early, skin cancer has an extremely high cure rate. While any form of cancer gives cause for concern, modern surgical techniques are becoming better and better at successfully treating skin cancer.

Cell re-growth is the major problem with most types of skin cancer. Techniques such as scraping or cutting are designed to completely remove cancer cells, but if diseased cells remain in the skin, it’s possible that they will begin to grow again.

Mohs surgery was designed to eliminate cell re-growth. This procedure entails using microscopes and a special mapping technique to determine the exact location of all cancerous cells in the skin. Doctors are then able to remove the cancer without fear of re-growth from remaining cells.

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What are some of the most common benefits of this procedure?
The most obvious benefit of Mohs surgery is the elimination of cancerous growths from the patient’s skin. Studies have shown that, in individuals who have had at least one failed skin cancer treatment, Mohs surgery is 96-98% effective in giving a complete cure. In contrast, other forms of surgery offer only a 50-75% chance of eliminating cancers in which other treatments have failed.

In other forms of skin cancer treatment, cutting or scraping often removes healthy skin as well as cancerous cells. But, by identifying exactly which cells are cancerous, Mohs surgery saves as many healthy cells as possible while eliminating each and every cancer cell.

If you're considering Mohs surgery, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a dermatologist with experience in Mohs surgery.
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What will happen in the initial consultation?
Before the doctor performs this procedure, he/she will arrange for a consultation with you. During this time, the doctor will explain the different options available to you, the procedure itself, and its risks and limitations. He/she will also explain the kind of anesthesia required, the location where it will be performed, and the costs.

Your doctor will begin with a complete medical history and an examination of your skin. He/she may ask to do a biopsy of the cancerous tissue in order to determine the type of cancer present. He/she may also take photos, and give you specific instructions on how to prepare for the procedure.

Take this opportunity to ask all the questions you have about the procedure. Also ask for, and follow up on, patient references. Learning everything you can about your options, risks and benefits is the key to making an informed decision. See Questions to ask your doctor below.
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How is the procedure performed?
During Mohs surgery, the doctor begins by removing the obvious and visible areas of growth on the skin by cutting or scraping. Next, an additional thin layer of skin is removed from the cancer site and injected with dye to help identify its original location on the patient’s body. The removed layer is then carefully examined under a microscope in order to determine whether any cancer cells remain. If none are found, then the surgery is complete.

If your doctor does find cancerous cells in the removed layer, he/she will remove another small layer of skin from the area where the cancer remains. He/she will repeat this process until certain that all of the potentially harmful cells have been removed.

After surgery, the remaining wound is usually closed either by sutures, a skin graft or a skin flap. In some cases, the wound is left to heal on its own.
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How long do the treatments take?
The removal of each layer of skin takes one to two hours. However, the entire procedure takes several hours. Time is allotted for preparation as well as for analysis of the tissue following the surgery.
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Where is the treatment performed?
Mohs surgery can be performed in the doctor’s office or in a surgical suite, depending on your preferences as well as your doctor’s. The procedure is generally done on an outpatient basis using a local anesthetic. Sometimes a mild sedative is administered as well.
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How much pain is there?
The amount of pain experienced varies from person to person, and depends on how much skin is actually removed. You should discuss your goals, budget, and pain tolerance with your doctor in order to help him/her determine the procedure, or combination of procedures, that will produce the best results for you.

After the procedure is performed, you should experience only minor discomfort. Your doctor may prescribe a mild pain medication to relieve these symptoms. You should avoid taking Ibuprofen and aspirin as they may increase bleeding.
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What can I expect afterward?
Some patients experience mild bleeding following the procedure. Your doctor may use a gauze pad combined with constant pressure in order to minimize this bleeding. Swelling, bruising and scabbing are common following Mohs surgery, and small areas of redness may develop around the wound. Most of these problems should disappear within five to seven days.
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Ideal candidate:
In general, the best candidates for Mohs surgery are:
  • Individuals with skin cancer around the nose, ears or eyes
  • Individuals with cancer on the surface of the skin
  • Mature enough to fully understand the procedure
  • Knowledgeable about the procedure
  • In good physical and psychological health
  • Non-smokers or able to stop smoking during the healing process
  • Realistic in their expectations
The above is only a partial list of the criteria that your doctor will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your doctor if he/she considers you an ideal candidate.
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Other important information:
There are a number of alternatives to Mohs surgery, including elliptical excision, freezing, and radiation. Each of these procedures offers a different way to eliminate skin cancer. Ask your doctor for help in determining which is best for you.
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Risks and limitations:
Because this procedure involves cutting as little healthy tissue as possible, the area of excision is kept to a minimum. However, it is common for patients to form scars wherever tissue is removed. If scarring is a problem, a second, minor procedure can be performed about two months after the original Mohs surgery.
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Costs:
Costs for this procedure vary, depending on the doctor, the location, technique used and the difficulty of the specific case.

Use our payment calculator to see what your monthly payments might be if you financed this procedure.

Apply now
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Choosing a doctor:
It is very important that you select a physician adequately trained and experienced in this procedure. We strongly recommend that you consider choosing a doctor who is board certified by the American Board of Medical Specialties. See our Physician Locator feature to find a dermatologist in your area, including detailed profile information for many of the listed doctors. Also read How to Select a Dermatologist for a more detailed discussion on choosing the right doctor.
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Questions to ask your doctor:
  1. Are the desired results I described realistic?
  2. Is there an alternative procedure that I should consider as well?
  3. Is there another form of skin cancer treatment I should try before undergoing Mohs surgery?
  4. What are the chances that I will experience a recurrence of skin cancer after Mohs surgery?
  5. How long will the procedure take?
  6. What kind of anesthesia is used, if any?
  7. How much does it cost?
  8. What is your experience in performing this procedure? (How long has he/she performed this procedure, and how many has he/she performed in the past year?)
  9. What percentages of patients have had significant complications? (The physician should disclose this information to you.)
  10. Will you repeat or correct the procedure if it does not meet agreed upon goals? And if the procedure must be repeated / corrected, will I be charged again? (The physician should provide you with his/her policy on this issue.)
  11. May I see "before and after" photos of recent patients? (The physician should provide many photos of recent patients.)
  12. Could I observe the exact procedure I am considering before I decide to have it done? (Either on videotape or live.)
  13. What should I expect after the procedure in terms of soreness, what to watch for, medication, bathing, and level of activity?
  14. Who will be assisting during the procedure? What are their qualifications? (Does the dermatologist perform the entire procedure?)
  15. Have you ever had your malpractice insurance coverage denied, revoked, suspended?
  16. Do you offer patient financing?
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Be sure to:
  • Tell your doctor about any allergies you have (to foods, drugs, environmental elements.)
  • Tell your doctor about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription), including such natural substances as Echinacea and St. John’s Wort.
  • Be sure to tell your doctor if you smoke. Smoking can lead to complications and poor healing.
  • Carefully follow any instructions your doctor gives you regarding eating and drinking.
  • Avoid aspirin and aspirin-containing medicines for two weeks prior to the procedure.
The information on this web site is only intended as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult a qualified dermatologist who can answer specific questions related to your situation.
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Related Articles
Please review the following articles for more information on this procedure.
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How do I finance this procedure?
Did you know that 29% of all Americans have considered having an elective procedure? Of those, 60% would schedule a procedure immediately if financing was available. With iEnchance's patient financing options, money no longer has to be the barrier between you and your new image. By filling out our on-line application you can qualify for a loan in as little as 30 seconds.
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*Top 5 Surgical Cosmetic Procedures in 2008:

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* Data collected from the American Society of Plastic Surgeons (ASPS)
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