Mohs Micrographic Surgery
What is Mohs Surgery?
Named after Frederic Mohs, the surgeon who developed the technique in the late 1930's, Mohs surgery is an outpatient form of excisional surgery which can effectively remove most skin cancers one layer at a time. After each layer is removed, it is examined under a microscope to determine whether residual cancer remains in the patient's skin and, if present, determine the location. The result is: 1) the removal of as little normal tissue as possible, and 2) the highest possibility for curing the cancer.
The Benefits of Mohs Surgery
- It is a highly effective means of treating common skin cancers with a success rate for the treatment of primary (never treated) basal cell carcinomas approaching 98%-99%.
- When used to treat basal cell carcinomas which have come back (recurrent), the success rate is about 95%.
- It is best used to treat skin cancers occurring in and around the face because cancers in this location can dive deep beneath the skin's surface. Mohs surgery aims to remove these invisible "roots" which can produce recurrences if not eradicated. The use of a microscope allows the surgeon to be precise, thereby preserving as much normal tissue as possible while optimizing the chance for cure.
- The patient does not have to be put to sleep and the procedure can be performed in a doctor's office.
How is Mohs Surgery Performed?
After the area is numbed with local anesthetic, the visible portion of the cancerous lesion is carefully scraped or removed so that the margins of the lesion are well defined. A 1 to 3 mm margin of tissue is marked beyond the scraped area and the lesion is removed along with the margin, which surrounds the lesion on the sides and underneath. Bleeding is controlled and a pressure dressing is applied to the wound and the patient is asked to return to the waiting room while the tissue is processed.
The tissue is carefully divided into pieces and the edges marked and color coded with special dyes. A special "map" is made of the treatment area corresponding to the color code used on the removed tissue. The tissue is taken to the laboratory where it is rapidly frozen, cut into thin sections, placed on microscope slides, and stained. Using the microscope, the surgeon determines whether any tumor persists. If an edge of the wound still contains tumor, it is noted on the patient map. That area is then removed in a subsequent stage: the patient is brought back into the surgery suite and, after the administration of additional anesthesia, another layer of tissue is removed from the appropriate location. The entire process is repeated until the physician is satisfied that the base and sides of the wound no longer contain cancerous cells.
The removal and preparation of tissue takes approximately 1 to 2 hours for each layer. You spend only 15 to 30 minutes of that time in the surgical suite. The remainder of time is required for tissue processing and evaluation. The average patient requires 1 to 3 stages for complete removal of the tumor. Therefore, by beginning early in the morning, Mohs surgery is generally completed in one day. Rarely, however, extensive disease may be encountered and require continued surgery on the following day.
Repair Surgery
Once all the skin cancer cells have been removed, you will be left with a surgical wound. Several options are available for repair. The options will be discussed with you, and we will recommend the one that can restore as much function as possible to affected structures and provide the best cosmetic result. Some repair options include:
- Spontaneous granulation. Skin tissues have a remarkable capacity to heal themselves and certain areas of the body will heal very nicely, thus requiring no further surgery. This type of healing allows observation when a difficult tumor is involved and recurrence is a consideration. At other times, wounds should be left to heal on their own with plans to use reconstructive surgery to treat the resulting scar at a later date.
- Closing side-to-side with stitches can very often provide excellent cosmetic results. This technique is best used on small defects and when the scar can be hidden in a wrinkle line.
- Skin graft. Grafting involves covering the wound with skin obtained from other parts of the body. Split-thickness skin grafts are thin shavings of skin usually obtained from the thigh. This can be used as permanent coverage or as temporary coverage prior to the final reconstructive procedure. Full-thickness skin grafts require a thicker layer of skin and are usually used as permanent coverage. Skin around the ear or collar bone is removed and stitched to cover the wound. The donor site is then sutured together.
- Skin flaps. Skin flaps involve the movement of nearby or adjacent healthy skin to cover the wound. This form of closure often provides excellent cosmetic results due to the match of skin texture, consistency, and color.
- Consultation with another reconstructive surgeon. If your surgery proves to be extensive or involves significant functional impairment, we will seek the help of a plastic surgeon for reconstruction of the defect. Usually, you will see the surgeon before or on the day that the Mohs surgery is performed, and the final reconstruction will be scheduled on or within a few days of Mohs surgery.
For Consultation and Referral
Dr. Lapinski completed a fellowship in Mohs Micrographic and Dermatologic Surgery at the University of Texas, and is a member of the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO). Please feel free to learn more about Mohs surgery by visiting the ACMMSCO Web site.
To make an appointment with Dr. Lapinski in Joliet or Frankfort, call:
| Call us at: 815-744-8554 |