Mohs Micrographic Surgery

Jason Michaels, M.D. is one of the few board-certified dermatologists in the area who is accredited to perform Mohs Micrographic Surgery. Dr. Michaels is a fellow member of the American Society for Mohs Surgery, and he offers the procedure daily in all Aspire locations.

 

Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. Mohs surgery is also known as Mohs micrographic surgery.

The goal of Mohs surgery is to remove as much of the skin cancer as possible, while doing minimal damage to surrounding healthy tissue. Mohs surgery is usually done on an outpatient basis using a local anesthetic.

Mohs surgery is an improvement to standard surgery (local excision), which involves removing the visible cancer and a small margin of surrounding healthy tissue all at once. Mohs surgery allows Dr. Michaels to verify that all cancer cells have been removed at the time of surgery. This increases the chance of a cure and reduces the need for additional treatments or additional surgery.

Mohs surgery is used to treat the most common skin cancers, basal cell carcinoma and squamous cell carcinoma, as well as some kinds of melanoma and other more unusual skin cancers.

Mohs surgery is especially useful for skin cancers that:

  • Have a high risk of recurrence or that have recurred after previous treatment
  • Are located in areas where you want to preserve as much healthy tissue as possible, such as around the eyes, ears, nose, mouth, hairline, hands, feet and genitals
  • Have borders that are hard to define
  • Are large or aggressive

We may recommend ways you can prepare for your surgery. You may be asked to:

Stop taking certain medications. Let us know of any medications or supplements you're taking, including any blood-thinning medications.
Clear your schedule for the day. It's not possible to predict how long Mohs surgery will take. For most people, the procedure takes less than four hours. But we may advise you to plan as though surgery will take all day, since there's a very small chance it could take that long.
Wear comfortable clothing. Wear casual clothes that are comfortable. Dress in layers so you can easily adapt if the room is warm or cold.
Bring something to help pass the time. Expect some waiting time during your Mohs surgery. Plan ahead by bringing a book, magazine or other activity to help you pass the time.

Mohs surgery is done on an outpatient basis in an operating room or procedure room that has a laboratory onsite that allows Dr. Michaels to examine the tissue after it's removed.

In most cases, the procedure lasts about four hours. But since it can be difficult to tell how extensive a skin tumor is just by looking at its surface, we often advise reserving the whole day for the procedure.

You likely won't have to change into a surgical gown unless the location of the tumor requires it. To prepare you for surgery, your surgeon or a nurse cleanses the area to be operated on, outlines it with a special pen and injects the area with a local anesthetic. The anesthetic numbs the skin, so you won't feel any discomfort during the procedure.

Once the anesthetic has taken effect, Dr. Michaels uses a scalpel to remove the visible portion of the cancer along with a thin, underlying layer of tissue that's slightly larger than the visible tumor. A temporary bandage is placed on your incision. This takes only a few minutes.

Dr. Michaels then takes this tissue to the laboratory for analysis. This portion of the procedure typically takes the longest amount of time.

Expect to wait in a waiting room for the surgeon to return. It may help to bring a book or magazine to pass the time. You'll be able to use the restroom or have a snack, if you need to, but you won't be able to leave the office until the procedure is complete.

While you're waiting, a technician cuts the tissue sample into sections and Dr. Michaels examines them with a microscope. Dr. Michaels takes great care to keep track of the exact spot where each piece of tissue was removed. That way, if a small area of cancer is found in one piece of tissue, the surgeon knows precisely where to continue with the surgery.

If cancer remains, your Mohs surgery will continue. Dr. Michaels removes an additional layer of tissue from the affected area, taking care to remove tissue that contains cancer while leaving as much healthy tissue as possible intact. Again, you'll wait while the surgeon examines the tissue in the laboratory.

The process is repeated until the last tissue sample removed is cancer-free. Local anesthetic can be re-administered as necessary.

After all of the cancer has been removed, you and Dr. Michaels can discuss your options for ideal functional and cosmetic reconstruction and decide on how to repair the wound.

Dr. Michaels understands that a good cosmetic result is an important part of the recovery process, and that's why he works so hard to leave as little tissue damage as possible.

One of the advantages of Mohs surgery is that you know your results right away and you usually don't leave your appointment until all of the skin cancer has been removed. You may have a follow-up visit with Dr. Michaels or referring doctor to monitor your recovery to make sure your wound is healing properly.

Though Mohs surgery has a high rate of cure for skin cancer, you will always have a small risk of cancer recurrence or of developing another skin cancer.

People who have been diagnosed with skin cancer have an increased risk of developing skin cancer again, compared with people who have never had skin cancer. As many as half of the people diagnosed with the most common types of skin cancer will develop another skin cancer again within five years.

Plan to undergo regular follow-up visits with your skin doctor or family doctor to spot any new skin cancer. Ask your skin doctor to create a follow-up schedule for you. How often you'll undergo follow-up skin exams depends on your diagnosis. Expect to have skin exams at least once or twice a year, and more often if your cancer was aggressive or is more likely to recur.