Mohs Surgery: Purpose, Procedure, Risks, Recovery

Mohs surgery is a form of skin cancer treatment. It involves surgically removing thin layers of skin, examining each layer for signs of cancer, and then continuing the process until no cancer cells are detected in the layers. The primary goal of Mohs surgery is to remove all skin affected by cancer while allowing the surrounding skin to remain intact and undamaged.

While other skin cancer treatments are available, Mohs surgery is considered the gold standard because of its top-line efficacy against two forms of skin cancer: basal cell carcinoma and squamous cell carcinoma. It can also be used to treat other forms of skin cancer.

This article discusses how Mohs surgery works, its benefits and risks, recovery from it, and success rates.

Should I Get Mohs Surgery?

Choosing the right cancer treatment is a personal decision. Your healthcare provider will walk you through all of your options and allow you to weigh the risks and benefits of each before deciding on one.

That said, if you have basal cell carcinoma or squamous cell carcinoma or are worried about cancer recurrence, Mohs surgery may be the best form of treatment for you. It’s also a good option for those looking for minimal scarring, less damage to the skin surrounding the area, and those who do not want to do more invasive treatments.

How Mohs Surgery Works

Mohs surgery is considered a less invasive option for skin cancer. The procedure is performed in one visit but in stages. The process is as follows:

• Exam and prep: A Mohs surgeon examines the area where skin cancer cells are found and marks it for reference. They position you so that they have the best access to the area for the procedure, and they put a surgical drape on the area. Local anesthesia numbs the area for the procedure, but the patient is awake the entire time.
• First stage removal: The Mohs surgeon removes a thin layer of cancerous tissue during the first stage removal using a scalpel. The goal of the first stage (as with every stage) is to remove the entire tumor.
• Lab analysis: When the tissue is cut out, it is color-coded with dye, the surgical site is mapped out, and the sample is sent to the lab to be frozen.
• Microscopic examination: After the tissue samples are ready, they are put onto a slide and examined under a microscope to check for remaining cancer cells. The location on the map is also marked. If necessary, another layer of tissue will be taken using the same process.
• Wound repair: After the final layer of tissue is removed (the one that determines all of the cancer has been cut away), the wound may be left open or closed to heal depending on the size and where it is located on the body. In some cases of more extensive wounds, a skin flap or graft consisting of surrounding tissue will be moved to the wound.
• Finishing the process: After the wound has been treated, you will receive instructions on wound care, scar care, and follow-up appointments. The entire process can take several hours to complete.

Conditions Treated With Mohs Surgery

Mohs surgery is typically recommended for people with basal cell carcinoma or squamous cell carcinoma. These cancers are rarely fatal because they grow slowly and don’t typically spread or spread so slowly that they are often caught early.   

When it comes to both cancers, Mohs surgery is typically recommended if:

• The cancer is aggressive, or the area affected is large.
• It appears in an area with thinner or fewer layers of skin with little tissue underneath, such as the nose, ear, scalp, genitals, hands, feet, or eyelids.
• The person has a compromised or suppressed immune system.
• It was already treated but recurred.

In some cases, Mohs surgery can also treat other forms of skin cancer. For example, a specific type of melanoma known as lentigo malignant melanoma or melanoma in situ can be treated using Mohs surgery if it is caught early enough.

Rare skin cancers, such as extramammary Paget’s disease, Merkel cell carcinoma, and dermatofibrosarcoma protuberans (DFSP) can also be treated using Mohs surgery in some cases.

Benefits and Risks of Mohs Surgery

There are various advantages to taking the Mohs surgery route for treating skin cancer. The benefits include:

• Complete removal of all cancer cells.
• High cure rate.
• Removing the exact tissue as opposed to just estimating.
• Leaving as much healthy tissue behind to reduce scarring and improve cosmetic outcomes.
• It is a one-day operation, allowing the patient to spend less time in treatment.
• It can, in some cases, permanently cure skin cancer when other treatments have failed.

One of the biggest disadvantages of Mohs surgery is that it isn’t as effective for other forms of skin cancer, such as some forms of melanoma. As is the case with all types of surgery, there are some potential risks and complications. Though Mohs surgery is considered exceptionally safe, some possible adverse events can develop, including:

• Infections
• Impaired wound healing
• Bleeding
• Nerve injury that can lead to functional loss of feeling in the area
• Scarring if the area needed a more extensive removal of skin

Preparing for Mohs Surgery

A person must do various things to prepare for Mohs surgery. Each precaution is taken at a set time before the procedure:

Two Weeks Prior to Surgery

Two weeks before your scheduled Mohs surgery, you will be asked to stop smoking because it can interfere with the way the wound heals following the procedure. You will also be asked to avoid certain medications that may increase the risk of excessive bleeding, including:

One Week Prior to Surgery

The week before surgery, you will have to prepare by eliminating certain products from your lifestyle that could cause an increased risk of raised blood pressure and increased bleeding. Those products include:

• Ginkgo biloba
• Ginseng
• Garlic
• Vitamins E and C
• Fish oil
• Other herbal supplements as recommended by your healthcare provider

24 Hours Prior to Surgery

On the day of surgery and in the 24 hours before it, you should avoid consuming alcohol of any kind. It can cause an increase in blood pressure and a higher risk of bleeding.

Day of Surgery

When the day of surgery arrives, you should do several things to ensure that you are well-prepared for the best possible outcome. They include:

• Taking a shower or bath to ensure that all surgical areas are cleansed and ready for the procedure
• Avoiding applying any makeup, lotions, or other products to the surgical area
• Taking all scheduled and prescribed medications (unless your healthcare provider directs you otherwise) and bringing a list of your medications to the appointment with you
• Eating normally
• Wearing comfortable and loose-fitting clothing
• Bringing a newspaper, book, and/or snacks to help pass the time because the procedure can run for up to four hours

Though you won’t go under general anesthesia, you may also want to bring a relative or friend with you to keep you company and for moral support.

Recovery and Aftercare

After the procedure is complete, there may be a repair process to close and care for the wound. It will include reconstruction options, such as a skin flap, to ensure the wound closes and heals effectively with minimal scarring. Typically, the fewer layers of skin that need to be removed, the less likely a person will require reconstruction.

The surgical team will also provide at-home care instructions to ensure you heal properly and avoid complications like infection. They include:

• When to change bandages
• When and how to clean the wound
• What medications to take to alleviate pain
• The timeline in which you can return to normal activities
• A schedule of follow-up appointments to monitor healing
• Scar treatment recommendations

These recommendations are not set in stone because each person is different, and their experience with Mohs surgery will vary significantly. Because healing is unique to the individual, the guidelines on aftercare will be too. That said, some general tips on aftercare include:

• Avoid bending, heavy lifting, rigorous exercise, or exertion.
• Be prepared for routine swelling and bruising that will typically reduce within five to seven days.
• Watch for signs of infection as the wound heals.
• Practice patience because the wound can take months to heal completely.
• Learn about the signs of skin cancer so you can recognize them if the cancer recurs.

Can the Cancer Come Back?

Mohs surgery is highly effective and can cure skin cancer in up to 99% of cases. However, the cancer can come back in the same area.

Research shows that the recurrence rate for those with basal cell carcinoma and squamous cell carcinoma is roughly 1.3 per 100 person-years and 4.5 per 100 person-years, respectively.

Success Rates and Follow-Up Care

Mohs surgery is a highly successful procedure with a cure rate of 99%. The cosmetic appearance following surgery is also better than other forms of treatment, with many people developing minimal scarring while keeping the healthy surrounding tissue intact.

Alternative Treatments for Skin Cancer

Some nonsurgical treatments for skin cancer include:

• Photodynamic therapy (PDT): Shines blue fluorescent light onto a topical medicine applied to the skin to kill abnormal cells.
• Imiquimod: A topical prescription cream that can treat actinic keratoses.
• Fluorouracil: A topical prescription cream that can treat actinic keratoses and basal cell carcinoma.

Alternative treatments may be helpful in treating skin cancer, but none offer the same efficacy as Mohs surgery. Little clinical evidence supports that many alternative therapies, especially herbal and botanical solutions, do much in the way of treating skin cancer.

When deciding between Mohs surgery and other treatment methods, weighing your options is crucial.

Summary

Mohs surgery is a minimally invasive form of skin cancer treatment with a 99% success rate. Because it is so highly effective at curing certain skin cancers, namely basal cell carcinoma and squamous cell carcinoma, it’s considered the gold standard of care.

People with other cancers, such as melanoma or other rare forms, may or may not be candidates for Mohs surgery, depending on the type and case. Because there are few side effects and the promise of minimal scarring following Mohs surgery, many people opt for the procedure over other forms of care to cure their skin cancer.

Before making any decisions, speaking to a healthcare provider about Mohs surgery and whether it’s right for you is essential. They will walk you through the procedure and allow you to make an informed decision regarding your care.