Mohs Surgery: Procedure, Risks, and Benefits

Introduction

Cancer incidences, particularly skin malignancies, are rapidly growing among people. Skin cancer is diagnosed in one out of every three cancer patients. Because damage to the ozone layer allows more ultraviolet light from the sun to reach the earth, it is anticipated that a 10% fall in ozone levels will result in 4500 additional instances of melanoma skin cancer. These rays are damaging to human skin and can cause cancer.

Excessive sun exposure raises the risk of melanoma, a skin cancer. For every malignancy, chemotherapy is suggested first, followed by other treatment options. Mohs surgery is the gold standard and most effective treatment for skin cancer.

What Is Mohs Surgery?

It is a micrographic surgical procedure to remove the skin lesion step by step. First, every layer of skin is removed one by one and examined under a microscope until the cancer skin or tissue is removed.

What Does Mohs Surgery Stand For?

Mohs stands for micro graphically oriented histographic surgery.

What Is Mohs Surgery Used For?

It is used to treat common head and neck skin cancers such as basal cell carcinoma, squamous cell carcinoma, etc.

What Are the Other Names for Mohs Surgery?

It is also called chemosurgery, microscopically controlled excision, histographic surgery, and Mohs micrographic surgery.

How Is Mohs Surgery Performed?

The technique for Mohs surgery is mentioned below:

1. The tumor/cancer is outlined, and local anesthesia is given. After anesthesia, if the tumor is visible, it is removed with a blade or scalpel.

2. The tissue layer is oriented or marked in a specific direction - usually 3 o’clock, 6 o’clock, 9 o’clock, and 12 o’clock.

3. A thin layer of tissue is removed at an angle of 45 degrees.

4. The removed tissue is cut into small pieces marked with colored dyes to map the tumor or cancer.

5. The removed tissue is examined under a microscope.

6. The remaining tissues on the affected skin region are removed if the tumor or cancer is identified under the microscope. This is repeated until cancer or tumor is not identified under the microscope. This ensures complete removal of the cancer skin with minimal healthy tissue removal.

7. After removing the tumor skin completely, different techniques are used to close the defect, such as grafts, flaps, second intention healing, etc.

Who Performs Mohs Surgery?

A dermatologist or Mohs specialist surgeon can perform Mohs surgery.

How Long Does Mohs Surgery Take?

The procedure time is not predictable and may vary from patient to patient. In general, it takes more than four hours.

When Is Mohs Surgery Necessary?

Mohs surgery is necessary in following cases:

• There is a high risk of cancer recurrence.

• Tissue conservation is important.

• High-risk patients who are immunocompromised or have a history of high-risk tumors.

• Skin cancer is present on the face with an aesthetic value, such as the nose, ears, lips, etc.

• The border of skin cancer is not clearly defined.

• Other treatments have failed.

How Long Does Mohs Surgery Take To Heal?

The Mohs surgery recovery depends on the type of wound. If the wound is left open to heal, it may take four to six weeks. If the wound is closed with sutures, it may take less time to heal.

What Type of Skin Is Mohs Surgery Performed On?

Mohs surgery is performed on common skin cancers such as basal cell carcinoma, squamous cell carcinoma, melanoma, and other uncommon skin cancers.

How to Prepare for Mohs Surgery?

It is an outpatient procedure but may require some preparations two weeks before the procedure to achieve the best possible outcome.

• Quit or stop smoking because smoking interferes with healing and may delay it.

• Avoid certain medications such as Aspirin and Ibuprofen because these may increase the risk of bleeding after the surgery.

• Avoid food items that may increase blood pressure and may result in increased bleeding, such as vitamin C, fish oil, garlic, etc.

• Avoid alcohol one day before surgery.

• Inform the doctor about pre-existing conditions such as heart problems, medications or therapy that an individual is taking, etc.

• On the day of surgery, wear loose-fitting, comfortable clothes.

• Avoid wearing makeup and other valuables.

• Eat a good and healthy breakfast.

What Are Mohs Surgery Aftercare and Recovery Instructions?

After the Mohs surgery, the patient may experience any of the following:

• Little or Minimal Pain and Discomfort: Although the intensity of pain and discomfort may depend on the location and size of the wound, acetaminophen (Tylenol) or Ibuprofen are effective in managing pain in most patients.

• Swelling and Bruising: Signs of inflammation may be visible within three to four days after surgery and may improve in a week. For example, swelling of the eyelids may be visible.

• Apply Ice Pack: To reduce the swelling, an ice pack for 20 minutes multiple times a day can be applied at the surgery site. For example, on the swollen nose or eyes, etc.

• Little or Minimal Bleeding: The patient may see little bleeding on the dressing after the surgery. If the bleeding is excessive, then the patient must consult the doctor.

• Avoid Physical Activity: Vigorous physical activity such as exercise should be avoided till one week after surgery because it may not allow the wound to heal.

What Are the Risks of Mohs Surgery?

Although Mohs surgery has a low risk of complications or side effects, a few commonly reported risks are:

• The surgery site will show a scar after complete healing. The scar usually fades away with time.

• Infection at the surgery site.

• Excessive bleeding at the surgery site. A little bleeding is normal.

• Loss of nerve function if the tumor affects the nerve present under the skin.

• Regrowth of tumor after surgery.

What Are the Benefits of Mohs Surgery?

The main advantages or benefits of Mohs surgery are:

• It allows maximum healthy skin or tissue preservation.

• It allows for precise control of tumor margins at the microscopic level.

• Cost-effective treatment.

• It includes single-visit outpatient surgery.

• Provides a high success rate of up to 99%.

Conclusion

The main goal of Mohs surgery is to treat skin cancer by removing the cancerous tissues from the skin while preserving the maximum healthy tissues. Excellent 5-year cure rates for non-melanoma skin cancers (NMSC) are reported via Mohs surgery. The process necessitates collaboration between the operating surgeon and the nurse in the operating room. Additionally, the Mohs lab requires at least one histotechnician to process tissue. For patient care, a well-coordinated team approach yields the best results.