What is Mohs Skin Cancer Surgery?
Mohs surgery, also called Mohs micrographic surgery, is a precision surgical technique that is used to remove all parts of cancerous skin tumors, while at the same time preserving as much healthy tissue as possible. Cancer cells can spread deep into the skin and almost tentacle-like, spread out and away from the superficial mole or bump on your skin. Removing all of the affected tissue is crucial to the success. One small cell left behind can start a cascade of new cancer growth. Mohs surgery offers the best techniques for discovering and removing all the “bad” cells.
Dr. Sikorski is a member of the American Society for Mohs Surgery and has the special training qualifications required to perform this highly effective surgery.
How is Mohs different from other types of skin cancer surgery?
The principle behind Mohs surgery is to remove all cancerous cells while minimizing removal of healthy tissue. Without Mohs, your doctor will excise the area of suspected cancer, send it to a lab, and wait several days for a lab report to find out if all the margins were clear of cancer cells. Because until that point it is not known if you will need additional excision, the area is left “open”.
If the pathologist verifies that all the cancer is removed, then your doctor will call you back (or send you to a cosmetic surgeon) to have the gap closed. If the pathologist says that there is still cancer visible in the specimen they received, then you will return to your doctor’s office, have more skin removed, and repeat the process. Mohs makes the process one step and allows closure or reconstructive work to be begin right away.
How is Mohs surgery done?
Mohs skin cancer surgery allows for the tissue to be examined through a microscope at the same time as the surgical removal to ensure that all of the cancer cells have been removed adequately. The surgical removal proceeds along a grid pattern with each layer carefully identified and mapped by the surgeon so that its exact location can be pinpointed on the wound. If any cancer cells are seen under the microscope, Dr. Sikorski can go back to that exact area and remove more tissue.
During this process, 100% of tissue margins are evaluated to ensure that the tumor is completely removed prior to repair of the skin defect In our office, the resulting defect (hole or gap created from removing the cancer) will be closed and/or reconstruction started by Dr Sikorski right away.
Steps in the Mohs surgery
Step 1: Anesthesia
The tumor site is locally infused with anesthesia to completely numb the tissue. General anesthesia is not required for Mohs micrographic surgery.
Step 2: Stage I – Removal of visible tumor
Once the skin has been completely numbed, the tumor is gently scraped with a curette, a semi-sharp, scoop-shaped instrument. This helps define the clinical margin between tumor cells and healthy tissue. The first thin, saucer shaped “layer” of tissue is then surgically removed by Dr. Sikorski. An electric needle may be used to stop the bleeding.
Step 3: Mapping the tumor
Once a “layer” of tissue has been removed, a “map” or drawing of the tissue and its orientation to local landmarks (e.g. nose, cheek, etc) is made to serve as a guide to the precise location of the tumor. The tissue is labeled and color-coded to correlate with its position on the map. The tissue sections are processed and then examined to thoroughly evaluate for evidence of remaining cancer cells. It takes approximately 60 minutes to process, stain and examine a tissue section. During this processing period, your wound will be temporarily bandaged while waiting for results.
Step 4: Additional stages – Ensuring all cancer cells are removed
If any section of the tissue demonstrates cancer cells at the margin, Dr. Sikorski will return to that specific area of the tumor, as indicated by the map, and removes another thin layer of tissue only from the precise area where cancer cells were detected. The newly excised tissue is again mapped, color-coded, processed and examined for additional cancer cells. If microscopic analysis still shows evidence of disease, the process continues layer-by layer until the cancer is completely removed.
This selective removal of tumor allows for preservation of much of the surrounding normal tissue. Because this systematic microscopic search reveals the roots of the skin cancer, Mohs surgery offers the highest chance for complete removal of the cancer while sparing the normal tissue. Cure rates typically exceed 99% for new cancers, and 95% for recurrent cancers.
Step 5: Reconstruction
Trained Mohs surgeons are experts in the reconstruction of skin defects. Reconstruction is individualized to preserve normal function and maximize aesthetic outcome. The best method of repairing the wound following surgery is determined only after the cancer is completely removed, as the final defect cannot be predicted prior to surgery. Stitches may be used to close the wound side-to-side, or a skin graft or a flap may be designed. Sometimes, a wound may be allowed to heal naturally.
Is it really better to have Mohs Surgery?
Having Mohs skin cancer surgery allows Dr. Sikorski to make sure all the cancer cells are removed, minimize removal of healthy tissue, and close the skin wound immediately. Minimizing tissue removal is especially important for eyelids, lips, the nose, ears, and other facial areas where loss of even a few millimeters of skin can make a big difference.
Does having Mohs surgery guarantee that the cancer won’t come back?
Using the Mohs microscopic surgery technique insures that all pathologically visible cancer cells are removed. Even so, it is still possible to get a recurrence of the cancer in the same area but the chances are greatly reduced. With Mohs skin cancer surgery, there is a 95% cure rate, compared to 70-80% for the conventional treatments.
Can only dermatologists perform skin cancer surgery?
Dr Sikorski is a board certified dermatologist and by definition, dermatologists are best qualified to deal with issues of the skin, but there other physicians or surgeons who have taken qualifying training for performing surgery. Be prudent and check credentials. With Dr. Sikorski’s dual specialty in dermatology and cosmetic surgery, you have the advantages of immediate medical resolution and esthetically pleasing resolution to the problem.
Will I have a scar?
Any time you cut the skin, you will have a scar. In most cases, the scar is barely perceptible. You can view photos of Dr Sikorski’s skin cancer reconstructions in the office to view the results of skin cancer reconstruction surgery.
Skin Cancer Surgery and Skin Cancer Reconstruction
Although large skin cancers can be seen with the naked eye, it takes a microscope to visualize cancer at the cellular level. The only way to prevent recurrence of localized skin cancer is to remove each and every cell; otherwise any remaining skin cancer cells can reproduce and cause a regrowth of the cancer.
Mohs surgery is a specialized method to remove skin cancer. It is named in honor of Frederick Mohs, the physician who developed the technique. Mohs surgery differs from other methods of treating skin cancer by the use of detailed mapping techniques and onsite microscopic examination of the surgically removed skin.
Mohs skin cancer surgery allows for the tissue to be examined during the operation through a microscope to ensure that all of the cancer cells have been removed adequately, and that removal of healthy, cancer-free tissue is minimized. Using the Mohs microscopic surgery technique there is a 95% or better cure rate. Mohs skin cancer surgery is then followed by careful reconstructive surgery to repair the defect (hole) and to yield an aesthetically pleasing result.
According to the American Cancer Society, there will be 1 million new cases of skin cancer this year, with the three most common types of skin cancer being Basal Cell Carcinoma, Squamous Cell Carcinoma and Malignant Melanoma. Basal Cell and Squamous Cell Carcinomas are usually localized and rarely spread to other parts of the body. When diagnosed and treated early, they are 95% curable. Malignant Melanoma is more serious as it has a propensity to metastasize (spread) to other areas of the body.
To reduce your risk of skin cancer, it is important to minimize sun exposure, wear sun protection daily, have full body skin examinations yearly (or more frequently if you have a personal or family history of skin cancer) and to recognize the signs and symptoms of skin cancer:
- Melanoma: Comprises 4% of all skin cancers and usually appears as a dark lesion or mole that has changed in appearance. Look for changes of the ABCD’s – Asymmetry, irregular Border, Color varied within the mole from one area to the other or black in color, and increasing Diameter or diameter larger than a pencil eraser.
- Squamous Cell Carcinoma: Comprises 16% of all skin cancers and is characterized by a rough, flaky, red or pink patch ofskin. At times these lesions can grow very rapidly, and are more common in smokers.
- Basal Cell Carcinoma: The most common skin cancer, comprising 80% of all skin cancers, it is characterized by a raised red or brown lesion or patch, with pearly, raised or rolled borders and an ulcerated raw or oozing center. Basal Cell Carcinoma usually grows slowly, and is more common in sun-exposed areas, such as the eyelids, ears, cheeks, lips, neck, and hands.
How to prepare for your Mohs surgery:
Two to three weeks prior to surgery avoid all medications on the enclosed list. If you are taking a medication prescribed by another Doctor, consult with him/her regarding discontinuing the medication.
What to expect on the day of your Mohs surgery:
The day of your Mohs procedure, please arrive at your scheduled appointment time. Expect to be here for a few hours. Eat a good breakfast and lunch. Wear comfortable clothing. We recommend bringing reading materials and food/beverage to make your visit more comfortable. In some Mohs procedures, a follow up visit the next day may be required.
Post-Operative Instructions :
- It is advised to take only Tylenol for pain due to the blood thinning properties of NSAIDs such as Aspirin, Advil and Aleve. Taking NSAIDs increases the chance of bleeding and/or hematoma. Please refer to the list of medications to avoid
- We recommend icing the area to reduce swelling and to help with pain unless otherwise discussed at the appointment
- If bleeding occurs, apply firm pressure for 20 minutes without letting go. If the bleeding still hasn’t stopped, please call the office for further assistance.
- The next day you can begin cleaning the area with soap and water and applying an antibiotic ointment to the incision site unless otherwise discussed at your appointment.
- We recommend keeping the area covered for one or two weeks. Covered, moist wounds heal with a better cosmetic result. If you notice any redness, irritation or allergic reactions stop using ointment and bandage and call the office if you have concerns. Paper tape and Telfa gauze can be used if you begin to have an allergic reaction to the Band-Aids.
- If you notice any signs of infection such as: fever, redness, swelling or pain at the surgery site, call our office immediately.
- No smoking! Smoking can interfere with the healing process of the skin.
You will be given specific post-op instructions before you leave our office. Refer to those for your personalized wound care guidelines. If you have any further questions please call our office at (949) 448-0487
For further information about Mohs surgery please refer to the American Society for Mohs Surgery Brochure.
Precautions Regarding Bruising for Mohs Surgery
Please review the following list of medications, herbs, and vitamins. It is very important that you DO NOT take any of the listed medications at least 3 weeks prior to your scheduled treatment date, as this can greatly increase your risk of bruising and excess bleeding. We also recommend that you do not consume any alcoholic beverages in this time frame as well. Many common herbs, over the counter medications, and prescriptions are capable of causing bruising during and/or after your treatment. If you are currently using a prescription drug prescribed by a doctor other than Dr. Sikorski, check with that physician to be sure it will be in your best interest to discontinue your medication(s) 3 weeks prior to your treatment date. Please take time to check all medications you are currently taking for any of the below listed ingredients!
Medications NOT recommended include but not limited to:
Recommended 7 days prior through 5 days after injections: (Both)
*Bromelain 500mg (pineapple enzyme) 1 tablet 2 times daily
*Arnica Montana 500mg 12C, 1 tablet every 6 hours
Herbs/Vitamins NOT recommended before procedure includes, but not limited to:
Ginseng (All Types)
St. John Wort
Chrysanthemum Parthenium (feverfew)
Leucanthemum (Oxe-Eye Daisy)
Chinese Red Sage
Hydrastis (Golden Seal)
Mahonia (Oregon Grape)
Populus Tremuliodes (Aspen)
Medications that ARE allowed for headache, pain or allergy: