Our Services > Procedures > MOHS Micrographic Surgery:
The term MOHS surgery refers to a highly specialized procedure for the total removal of skin cancer. MOHS, as an acronym, stands for Microscopically Oriented Histographic Surgery.
MOHS surgery involves three separate steps: (1) application of a chemical fixative to the visible part of the skin cancer, (2) surgical removal (or excision) to a certain depth of that tissue after the chemical has penetrated the skin, and (3) examination of this excised tissue under the microscope.
Before this tissue is examined, it is marked with colored dyes to distinguish top from bottom and right from left. By doing this, we are able to pinpoint the exact location of any remaining tumor during the microscopic examination. If more cancer is found, the entire procedure is repeated, but only in the area of the remaining cancer. This is the "Mohs fixed tissue technique".
More commonly, we do not need to apply the fixative. We call this modification the "Mohs fresh tissue technique". It is undertaken after local anesthesia. However, the rest of the procedure, including marking with dyes and examination under the microscope, remains the same. Only with the careful, systematic microscopic examination of the removed skin can one be as certain as possible that no cancer remains. More than 90% of the cases are now treated by the fresh method.
Using the MOHS technique, the percentage of success is very high, often 95%-99%, even if other forms of treatment have failed. The MOHS surgeon can pinpoint with the microscope the areas where there is cancer and selectively remove tissues only from those aeras. In this way, the skin cancer is traced out to its roots with little guesswork involved, which results in (1) the removal of as little normal tissue as possible and (2) the highest chance of curing the patient. Other forms of therapy frequently have only a 50-70% chance of success in curing skin cancers that have had previous treatment that failed.
MOHS surgery will leave a scar. However, the MOHS procedure tends to minimize this as much as possible.
Total removal of a skin cancer, which may involve several surgical sessions, is usually completed in one day. After the surgery, a decision is made as to the bet way to manage the wound created by the surgery. There are usually three choices as to how to close this wound: (1) to close the wound with stitches, (2) to let the wound heal by itself, and (3) to cover the wound with a skin graft or flap.
Possible complications from MOHS surgery are (1) sensitivity to the ointment used to dress the wound or reaction to the adhesive tape,, which would be characterized by severe itching with extensive redness and (2) bleeding after surgery. These however, are very unlikely.
After MOHS surgery, we ask for a follow-up period of observation at intervals for at least 5 years. This will aid in determining whether there was a recurrence of the skin cancer and it can be detected early and treated. Also, studies show that once you develop a skin cancer, there is a high risk that you will develop others in the years ahead. A complete body check by your dermatologist once a year is the best way to detect any new skin lesions or skin cancers and get them treated. |
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