The pathologist looks for skin cancer at the margins of each section, but these are only a fraction of the actual excision margin. In Mohs surgery, the histological processing takes place on the day of surgery and the wound is only closed after it has been confirmed that the entire cancer has been removed.
If any tumour is visible in these sections, it means that the excision is incomplete and the patient requires a further Mohs stage. A mapping process and colour coding system is used during Mohs surgery to precisely localise any remaining cancer , and tissue is only removed if it contains cancer. This process preserves healthy tissue. Mohs surgery yields higher clearance rates than standard excision , and smaller wounds — therefore better cosmetic results.
Mohs surgery is usually undertaken as a single day procedure under local anaesthesia. It involves the following steps:.
The steps involved in Mohs surgery
Although different criteria are used across the globe, the main reason to perform Mohs is to minimise the risk of incomplete excision. This reduces burden to the patient and may avoid large and costly re- excisions later. Mohs may also be appropriate when a large reconstruction is needed to close the defect or when the tumour is located in a cosmetically sensitive area. In , a joint effort by various medical organisations in the USA led to the development of appropriate use criteria for Mohs surgery.
There is plenty of evidence that Mohs is the best form of surgery for high risk basal cell carcinoma and squamous cell carcinoma. Large trials comparing Mohs to standard excision for other types of skin cancer are lacking. This can be challenging in some skin cancers, such as:. This allows the use of immunohistochemical markers to help identify tumour cells. Such techniques are sometimes collectively referred to as slow Mohs. They include the 'Tuebingen Cake', and 'Muffin' techniques .
Mohs surgery leads to fewer tumour recurrences than standard excision of basal cell carcinoma and squamous cell carcinoma. In a randomised clinical trial with year follow-up, recurrence rates were:.
You stay awake for the procedure. Remove the visible tumor along with a thin layer of tissue next to the tumor. Look at the tissue under a microscope.
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Check for cancer. If there is still cancer in that layer, the doctor will take out another layer and look at that under the microscope. Keep repeating this procedure until there is no cancer found in a layer.
Each round takes about 1 hour. The surgery takes 20 to 30 minutes and looking at the layer under the microscope takes 30 minutes. Do about 2 to 3 rounds to get all of the cancer. Deep tumors may need more layers. Stop any bleeding by applying a pressure dressing, using a small probe to heat the skin electrocautery , or giving you a stitch. Why the Procedure is Performed. Mohs surgery may be preferred when the skin cancer is on an area where: It is important to remove as little tissue as possible, such as the eyelids, nose, ears, lips, or hands Your doctor needs to be certain the entire tumor is removed before stitching you up There is a scar or prior radiation treatment was used There is a higher chance the tumor will come back, such as on the ears, lips, nose, eyelids, or temples Mohs surgery may also be preferred when: The skin cancer was already treated, and it was not completely removed, or it came back The skin cancer is large, or the edges of the skin cancer are not clear Your immune system is not working well due to cancer, cancer treatments, or medicines you are taking The tumor is deeper.
While rare, these are some risks for this surgery: Infection. Nerve damage that causes numbness or a burning sensation. This usually goes away. Larger scars that are raised and red, called keloids.
Mohs surgery - Mayo Clinic
Before the Procedure. Your doctor will explain what you should do to prepare for your surgery. You may be asked to: Stop taking certain medicines, such as aspirin or other blood thinners. DO NOT stop taking any prescription medicines unless your doctor tells you to stop.
Stop smoking. Arrange to have someone take you home after your surgery. After the Procedure. Your doctor will talk with you about your options: Let a small wound heal itself. Most small wounds heal well on their own. Use stitches to close the wound. Use skin grafts. The doctor covers the wound using skin from another part of your body.
Use skin flaps. The doctor covers the wound with the skin next to your wound. Skin near your wound matches in color and texture.