A Guide to Mohs Surgery
Last updated: February 2022
Chances are if you're living with skin cancer, you've heard of Mohs surgery. It is, after all, one of the most effective ways to treat skin cancer. both basal cell carcinoma and squamous cell carcinoma. Even if you’ve heard of Mohs surgery, you may not realize how it works. Here is a guide to Mohs surgery, and what to expect.
What is Mohs surgery?
Originally called chemosurgery, Mohs surgery is a micrographic surgery that is performed in stages. While it was pioneered in the 1930s, it wasn’t until the 1960s that it became more widely known as a treatment for skin cancer. Fast forward to today, and it’s one of the most frequently utilized forms of skin cancer treatment there is.
How does Mohs surgery work?
There are two medical professionals that play major roles in Mohs surgery for skin cancer: a surgeon and a pathologist. These two professionals perform three distinct tasks:
- Removal of the cancer
- Analysis of the removed specimen
- Closing of the wound
While each step is performed, you can expect to wait while each specimen is examined to ensure that all of the cancer has been removed. If it hasn't, the surgeon will continue to remove cancer from the area.
Let's walk through the steps
Prep the area
First, the area where the surgery will be performed is prepped. A local anesthetic is used to numb the area to make you more comfortable. As a local anesthetic is used, you’re awake during the procedure, but you should not feel pain or discomfort. You may feel pressure or a tugging sensation, but that should be it.
The surgeon starts by removing the top layer of your skin cancer, after which that tissue is sent to the lab It is analyzed, and if it is determined that cancer still exists in your skin, more layers are removed.
The analysis and wound dressing
A technician looks at each layer of skin after freezing it. Under a microscope, they can see if any cancer cells are still present. If all of the cancer was removed in that layer, the wound can be closed up with stitches or left open to heal; it all depends on the circumstances. In fact, a lot depends on so many factors, like where the surgical site is located or if there needs to be a skin graft.
You may have reconstructive surgery on the same day
Many dermatologists have a plastic surgeon in-house, so you can immediately have reconstructive work performed if necessary. For example, I had Mohs surgery performed due to skin cancer on my face. After round one of Mohs surgery, I had plastic surgery on a small portion of my face. Well, when I say small, I mean I had over 20 stitches. In retrospect, I guess that doesn’t seem small at all. But it seemingly didn't take too long. For obvious reasons, if multiple layers of skin need to be removed to ensure that all of the cancer is gone, the surgery can take much longer, and you may be there for a few hours. I was lucky to have it all removed in one pass.
It doesn't have to be scary, I promise!
Mohs surgery is considered one of the best treatment options for both squamous cell carcinoma and basal cell carcinoma cancers. It doesn’t have to be scary, either. I wasn’t in pain while the surgery was taking place because my doctor properly numbed the area with anesthesia. All you should feel is a little pressure. And keep in mind, while you're sitting in the waiting room, chances are your fellow patients are also waiting to have Mohs surgery; you are not alone. Plus, depending on current COVID restrictions, you can usually have a family member or friend with you while you wait in between passes.
What has your experience with Mohs surgery been like?
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