Mohs Micrographic Surgery
What is Mohs Micrographic Surgery?
Micrographic surgery is a very specialized way of treating skin cancers. It offers the highest possible cure rates while removing as little normal skin as possible. It is generally reserved for the treatment of lesions that have recurred following another therapy or cancers in technically challenging locations such as the nose, ear or eyelid. Micrographic surgery is also called Mohs surgery in honor of Dr. Frederick Mohs who developed the technique.
What is Skin Cancer?
The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. Fortunately, these cancers are rarely life threatening but they continue to grow if not treated and can be destructive or disfiguring. The third most common skin cancer is melanoma which is very curable if diagnosed and treated at an early stage. However, melanoma can be deadly if not treated early and, therefore, often requires more aggressive treatment.
How is the Cancer Treated?
There are various treatment options for the common types of skin cancer (basal cell carcinoma and squamous cell carcinoma). The specific treatment chosen depends upon several factors and may include freezing the lesion, removing the cancer with a special instrument known as a currette, excising the growth with surgery, treating with x-rays or even using a cream. However, micrographic surgery offers the highest available cure rate of all skin cancer treatments. 99% of basal cell carcinomas are cured with this surgery if the cancer has not been treated before. Over 96% of these cancers are cured following micrographic surgery even if other treatments have failed.
Will I be Hospitalized?
No. Micrographic surgery is an outpatient office procedure and you will be able to return home the same day. You will be awake during the procedure but may be offered a medication to reduce anxiety.
What Happens on the Day of Surgery?
Your appointment will be scheduled early in the day. Our staff will escort you into a surgical suite where the surgeon will discuss the procedure, answer questions and carefully numb the area around the skin cancer. Once it is numb, the visible cancer and a thin layer of tissue will be removed. This tissue is thoroughly mapped and coded by the surgeon and taken to the adjoining laboratory where the technician processes the microscope slides. You will have a temporary dressing placed over the wound and will be free to return to the waiting room.
The surgical procedure usually takes only 15-20 minutes. However, it takes a minimum of 1-2 hours in the laboratory to process and examine the tissue. You will be asked to wait in the waiting room while the laboratory work is being done. If remaining cancer is found, you will be brought back to the surgical suite and a second thin layer will be taken from that area. This will also be taken to the laboratory for processing while you wait. Although there is no way to tell before surgery how many stages will be needed, most cancers are removed in three stages or less. Often the surgery lasts the entire morning or longer. Since we do not know in advance how much time will be needed to remove the cancer and repair the wound, we ask that you make no other commitments for the entire day of your surgery.
Often, the hardest part of the procedure is waiting for the results from the laboratory. We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material or another diversion to occupy your time. Magazines, beverages and light snacks are provided. You may also wish to pack a lunch in case your visit extends through the lunch hour. Your companion may also visit one of several local restaurants and bring you back something to eat since you are asked not to leave the waiting area until all surgical procedures are completed.
Will the Surgery Leave a Scar?
Yes. Any form of skin cancer surgery will leave a scar. However, because micrographic surgery removes as little normal tissue as possible, scarring is minimized. After the cancer is removed we may choose to: (1) let the wound heal by itself, (2) close the wound with stitches or (3) reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result and will be thoroughly discussed with you the day of your surgery.
Will I have Pain After the Surgery?
Most patients do not complain of much pain after surgery. If there is any discomfort, Tylenol is usually adequate for relief. Avoid taking other over-the-counter pain medications as they may cause increased bleeding. On occasion, prescription pain medication may be provided by the physician.
Will Insurance Cover This Procedure?
In most instances, your carrier will cover the cost of the procedure. However, depending on your specific plan, you may be required to obtain a referral from your primary care physician or prior approval from your insurance company for the surgery.
Important: Please contact your insurance carrier before your surgery date to make sure all necessary authorizations and referrals have been obtained. Failure to comply with your insurer's requirements may result in a delay in your surgery or a significant increase in your out-of-pocket payment responsibility.
You will be responsible for any deductibles or co-payments required by your insurer.
We will submit a claim to your insurance company for you. Please bring any necessary information (including the mailing address of your insurance company) with you to your visit.
If you have any questions, please contact us at (828) 264-4553.
Preparing For Surgery
Please complete the medical history form and bring it with you on the day of surgery.
Continue any medications (including blood thinning medicines such as aspirin, coumadin, Plavix, etc) prescribed by your doctor. While some of these medications may increase bleeding, recent evidence has shown that the risk of bleeding is quite low for this type of surgery. Additionally, patients who stop these prescriptions are at higher risk for complications such as heart attacks, strokes and blood clots.
However, if your doctor has not specifically told you to take it, we ask that you avoid aspirin for at least 10 days prior to surgery. Other pain medications which can increase bleeding include ibuprofen (Advil, Motrin, Nuprin) and naproxen (Aleve) and should also be discontinued. Tylenol does not increase bleeding and may be taken any time before or after surgery.
If you are taking coumadin, please notify our office before your scheduled surgery date as we may need to contact your doctor and/or obtain a blood test (Protime or INR) prior to the procedure.
If you have typically taken antibiotics prior to surgical or dental procedures due to joint/heart valve replacement, heart murmur or another reason, please inform our staff. Recommendations for the use of these antibiotics have been updated and we will gladly guide you to keep you safe and conform to the most up-to-date medical recommendations.
Alcohol will also increase bleeding, so please avoid alcoholic beverages for at least 24 hours before and after surgery. Tobacco products can significantly hinder the healing process and should ideally be avoided for the week following surgery.
Wear comfortable clothing, preferably with a button-down shirt/blouse. Please do not wear any make-up, lotions or perfume when scheduled for facial surgery.
We strongly suggest that you arrange to have a companion drive you to and from the clinic on the day of your surgery. You may also be more comfortable with someone to keep you company in the waiting room.
Eat a normal breakfast on the day of surgery.
Please be prepared to limit your activities following surgery to allow for the most optimal healing. You will likely be asked to stay out of work and/or avoid certain other activities such as exercise in the immediate post-operative period.