Mohs Micrographic Surgery

What is Mohs surgery?

Mohs surgery is a special type of skin cancer surgery, named after its inventor, Dr. Frederic Mohs. Mohs surgery involves the surgical removal of skin cancer with a special technique where all of the skin margins are evaluated with a microscope. It is a highly specialized procedure for the total removal of skin cancers.

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What are the advantages of Mohs surgery?

Mohs surgery allows for the total removal of a skin cancer in one day, with the advantage of finding out the results the same day. 100% of the margins of the skin removed are examined with a microscope, which reduces the possibility of having to “go back” to remove more skin later if all of the cancer was not removed.

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Our Mohs surgeons at Kuchnir Dermatology & Dermatologic Surgery will examine your skin cancer under a microscope, allowing us to pinpoint the area where there is skin cancer remaining. If we observe any skin cancer under the microscope, we can then remove this cancer only from the involved areas in a second or third layer (the same day) if needed.

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Because we examine all of the margins of the skin removed, the percentage of success is very high, often 95-98%, even if other previous treatments have failed. However, no one can guarantee a 100% chance of cure. Also, because we only remove tissue where we see skin cancer with the microscope, we remove as little normal tissue as possible.

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We, and your referring physician, are happy to further explain the risks, benefits and alternatives for treatment of your skin cancer, and why we believe Mohs surgery is the best treatment option for you.

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Preparing for my day of Mohs surgery?

We may ask to see you in consultation prior to your surgery, or we may perform the consultation on the same day as your surgery. The night before the surgery, get a good night’s rest, eat a light breakfast and come to the office at your scheduled appointment time.

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As the surgery can take several hours with some downtime, we recommend that you bring a book, newspaper, laptop computer or something else to help pass the time. Many patients bring a snack or lunch to eat during the day.

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You should wear comfortable, loose-fitting clothing for the day of the surgery. Our office can be slightly cold, so it is a good idea to also bring a sweater with you.

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We ask that you have someone available to drive you home after the surgery.

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What about my other medications?

You should continue to take all of your regular medications, unless specifically instructed by our office staff. If your doctor has prescribed a blood thinner such as Coumadin, Plavix, heparin, aspirin, we recommend that you continue taking these medications as prescribed.

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What will my day of Mohs surgery be like?

On the day of your surgery, you will come to our Milford office, located at 1 Maple St, Milford, MA 01757. You will then be seen by our Mohs surgeon, Dr. Carl Schanbacher.

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After taking a brief history, we will perform a limited skin exam, and mark the site of your skin cancer with you. We will then inject a local anesthetic to numb the skin and prevent discomfort for you. Our surgeon will then remove the affected area with a thin layer of tissue. We will stop the bleeding and place a large bandage over the area.

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We will then take your skin and prepare the tissue for microscopic examination. This is unfortunately, the most time consuming part of the process, as it can take 1-2 hours for the tissue and slides to be prepared. We will then examine the slides of your skin under a microscope, in order to determine if there is any skin cancer still remaining.

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If there is skin cancer seen on your slides, it means that there is still skin cancer at the edges of the tissue. We must remove more tissue (“another layer of tissue”), and we will repeat the above process until all of the skin cancer is removed. Depending on your skin cancer, it may take several stages of this process in order to completely remove the skin cancer. We cannot predict how many stages of surgery will be necessary to remove your skin cancer.

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Once the skin cancer is completely removed, we will then discuss the different options to help the wound heal. Depending on the size and location of your skin cancer wound, we will discuss all of the different surgical reconstructive options with you and recommend the best option in our opinion. Typically, this reconstruction is performed the same day as your Mohs surgery, but it may be necessary to perform the reconstruction on a separate day.

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Will I be left with a scar?

Unfortunately, all surgeries result in scars. When we remove your skin cancer, the procedure will result in a scar.  Dr. Schanbacher has great expertise in reconstructing skin cancer wounds in all locations as a result of his specialized training in Mohs surgery. In some cases, a minor revision to the scar may be necessary in the future to result in the best cosmetic outcome. We refer few cases out for reconstruction. We do work with colleagues in plastic, head and neck, and oculoplastic surgery, and we are happy to refer you to them for reconstruction after Mohs surgery if you desire.

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What do I do after Mohs surgery?

After your surgery, we will see you back to observe the wound and to make sure that the incision has healed well. You may also need to have sutures removed at that time. In the future, we recommend that you have regular visits with the dermatologist for full skin checks in order to maintain skin health.

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Checklist for your day of Mohs surgery

1. Sleep well the night before, and eat a light breakfast before coming to our office.

2. Take all of your regular medications, including any blood thinners, unless specifically instructed not to do so by our office.

3. Bring a book, magazine, laptop, or other form of entertainment, as you should expect to spend the day in our office.

4. Dress comfortably in loose clothing. Bring a sweater in case you get cold.

5. You may want to bring a snack and/or lunch, as the procedure can last all day.

6. Have someone available to pick you up from our office when the procedure is completed (we will let you know about 30 minutes prior to the end of the procedure).
    

If you have any further questions, please feel free to contact our office at 508-478-2610. Thank you very much, and we look forward to caring for you here at Kuchnir Dermatology & Dermatologic Surgery.

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