Mohs Surgery for Skin Cancer: What Is It?

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Mohs surgery is a specific surgical technique that allows dermatologic surgeons to achieve precise control of surgical margins when operating on skin cancer. It is considered to be the best available method of excision for most skin cancers of the head and neck, including recurrent or aggressive tumors.

Mohs surgery is an advanced technique used by specially trained cosmetic dermatologists and surgeons which provides the opportunity to successfully treat difficult malignant lesions, including basal cell carcinoma, aggressive forms of squamous cell carcinoma, and other aggressive skin lesions. The American College of Mohs Surgery will only accept physicians as members after they have completed an additional one to two years of training after residency, so membership in the American College of Mohs Surgery is an indication of true expertise.

When removing a tumor, a surgeon’s goal is removal of all malignant cells while leaving behind healthy elements of skin to promote healing. Traditional methods of removing malignant tumors have always involved excision of the tumor with removal or additional surround tissue, known as a “margin.” This is done to prevent extension of malignant cells that may not be have yet formed a visible tumor. Sometimes, a tumor can be removed and biopsies of the margin may appear benign, when in reality, there may be microscopic extensions of the tumor that weren’t identified or that may have been missed by chance in a particular biopsy specimen. This results in recurrence, although it may not be immediately evident.

Mohs surgery offers greater precision in determination of accurate tumor margins that may result in a smaller scar and less disfigurement. Using a microscope and special stains to examine specimens of tissue obtained during the Mohs procedure, the dermatologic surgeon is able to map exactly where the cancerous cells stop and the good tissue begins. The procedure is done with use of local anesthetics, and multiple injections are often required. Advantages of Mohs surgery include better cosmetic results and the ability to remove tumors that otherwise might have a high risk of recurrence

Mohs surgery is time consuming and may take more than one day for tumor removal in cases of aggressive or large tumors. Because of this, reconstruction of the surgical scar may not be immediately possible. Additionally, dermatologists and their staff members must be carefully trained in these surgical techniques. In some cases, after excision of the tumor, patients may require additional treatment, including chemotherapy or radiation. Some tumors are simply too large and difficult to remove surgically. Recurrences can also occur when there are multiple tumors that may be disconnected. All surgical procedures carry risks, including bleeding and infection. Nerve damage can also occur.

Before undergoing Mohs surgery, a thorough preoperative evaluation will include review of your skin tumor, in addition to review of your general health and current medications as well as review of your past medical and surgical history and any complications, such as keloid formation and scarring. Your surgeon will advise you to stop smoking and drinking alcohol during the period before and after your surgery. Since the surgery is performed under local anesthetic, you can eat a hearty breakfast. This is advisable on the day of surgery, because the procedure is a lengthy one. You should take your regular medications on the day of surgery and make arrangements to be driven home if your surgery involves a lesion that is near the eye. If your lesion is located in an area that is associated with a high risk of infection or if you are diabetic or have a suppressed immune system, you may be advised to take antibiotics to prevent infection before surgery. Most patients will also take antibiotics for a week after surgery.

If you are interested in learning more about treatment of a cancerous skin lesion with Mohs surgery, call today for a consultation with Dr. Mehrabi in one of our convenient offices in Beverly Hills, Encino, or Glendale. Our staff will be happy to arrange your appointment.

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