MOHS Micrographic SurgeryMOHS surgery is a specialized, highly effective technique for removing skin cancers. It was developed in the 1930s by Dr. Frederick Mohs at the University of Wisconsin and is now practiced throughout the world. MOHS surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancer tissue; so that all roots and extensions of the cancer can be eliminated. MOHS surgery has the highest reported cure rate of all treatments for skin. Treating all skin cancers with MOHS surgery is not necessary. MOHS surgery is reserved for skin cancers that grow back after previous treatment, cancers that are at high risk of recurring, or cancers that are located in cosmetic areas where preservation of the maximum amount of normal skin is important.

Why remove skin cancers with MOHS Surgery? Some skin cancers are deceptively large—far bigger under the skin than they appear to be from the surface. These cancers may have "roots" in the skin or along blood vessels, nerves, or cartilage. Also, skin cancers that recur after previous treatments may send out extensions deep under the scar tissue that has formed. MOHS surgery is specifically designed to remove these cancers by tracking and removing these cancerous "roots".

How is MOHS surgery done?There are three steps involved in MOHS surgery:
The skin is made completely numb using a local anesthetic. The visible cancer is removed with a thin layer of additional tissue. This takes only a few minutes and the patient may then return to the waiting room. A detailed diagram (a MOHS map) of the removed specimen is drawn.

The specimen is color coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. These slices are placed on part of the procedure, often requiring an hour or more to complete.

The slides are then carefully examined under the microscope. This allows examination of the entire surgical margin of the removed tissue. All microscopic roots of the cancer can thus be precisely identified and pinpointed on the MOHS map. If more cancer is found on the microscopic slides, the additional tissue can be removed only where cancer is present. This allows the MOHS surgery technique to leave the smallest possible surgical defect because no guesswork is involved and the cancer is removed.

How long does it take? Most cases can be completed in three or fewer stages, requiring six hours or so. However, no one can predict how extensive a cancer will be because the size of a skin cancer's "roots" cannot be estimated in advance. Quality health care is our first priority. This procedure cannot and will not be rushed. The removal of aggressive skin cancer requires your patience, as it can be a lengthy procedure. We therefore ask that you reserve the entire day for surgery.

Get a good nights rest and eat normally the day of surgery. If you are taking prescription medications, continue to take them unless otherwise directed. However, avoid taking medications that contain aspirin for ten days prior to your surgery. Please check with your primary care physician or cardiologist to make sure that it is ok to stop the aspirin for this amount of time. Also, please do not take Advil, Motrin, Naprosyn, vitamin E, garlic tablets, ginko biloba, or alcoholic drinks within 7 days of surgery. Do not discontinue Coumadin or other medicines taken for your heart or stroke before checking with the doctor first. You may, however, take Tylenol at any time before surgery. You may want to bring a book or magazine with you to occupy your time while waiting for your slides to be processed and examined. We recommend that you arrange for someone to drive you home after surgery is completed.

Will I have pain, bruising, or swelling after surgery? Most patients do not complain of significant pain. If there is discomfort, Tylenol is usually all that is necessary for relief. However, stronger pain medications will be prescribed when needed (Please see post-operative instruction sheet). You may have some bruising and swelling around the wound, especially if surgery is being done close to the eyes.

Will my insurance cover the costMost insurance policies cover the costs of MOHS surgery and the surgical reconstruction of the wound. Please check at the front desk to confirm that your insurance is accepted here.