What Is Mohs Micrographic Surgery?
Mohs micrographic surgery is a special procedure for the treatment of skin cancer. Your surgeon removes the skin cancer in a very specific way, and there is a specialized laboratory right in the clinic that produces microscopic slides that show the complete cancer margins. These slides are made within a few hours while you are waiting in the clinic. Your surgeon then studies these slides to determine if the cancer roots are completely removed or if further surgical removal is needed.
Once your surgeon has completed the cancer removal, the resulting wound may be left to heal on its own, or the wound may be reconstructed using a skin flap or skin graft.
Dr. Taher attributes the success of his Mohs surgery practice to the amazing team of nurses, medical office assistants, and lab histotechnicians at the Edmonton Dermatology and Skin Surgery Centre
What is so special about this surgery?
In Dr. Taher’s case, he completed his dermatology training at the University of Alberta, and then successfully completed a prestigious fellowship in Mohs micrographic surgery, cutaneous oncology, and reconstructive surgery in Los Angeles and Santa Monica, California. During his training, he operated out of UCLA (University of California, Los Angeles), USC (University of Southern California), Martin Luther King Hospital, and at St.John’s Medical Plaza in Santa Monica.
The surgery combines expertise in understanding the behavior of various skin cancers, having the surgical skills to precisely remove these cancers, and skills to interpret pathologic slides under the microscope. This is in addition to having skills in performing reconstructive skin surgery.
Mohs surgery is beneficial for tumors in areas where you want to minimize taking out good skin. For example, on the face, or near critical structures. The technique is also effective in dealing with tumors with complicated roots that are aggressively invading the skin, or for tumors that have margins that are difficult to identify on the surface of the skin.
Skin Cancer site is confirmed
Area is anesthetized with local anesthetic
The visible margins of the tumor are removed using a scalpel
The tissue is sent to the in-house laboratory for making slides
Your surgeon studies these slides under a microscope to look for any positive tumor roots.
If there are positive roots, further tissue is removed. This is continued until the cancer roots are gone (margins cleared).
Once the margins are clear, your surgeon will discuss how to manage the wound leftover. This may involve healing on its own, a skin graft or a skin flap.
How Long Does Mohs Micrographic Surgery Take?
Total removal of the skin cancer, which may involve several surgical stages, is usually completed in one day. After the surgery, a decision is made as to the best way to manage the wound created by the surgery.
How Effective Is Mohs Micrographic Surgery?
Using the Mohs micrographic surgical technique, the percentage of success is very high, often 95% to 98%, even if other forms of treatment have failed. Therefore, with this technique, an excellent chance of cure is achieved. However, no one can guarantee a 100% chance of cure.
What Are The Advantages Of Mohs Micrographic Surgery?
After the initial tissue is removed, the surgeon can pinpoint with the microscope the areas where there is cancer and selectively remove tissue only from those areas in the following surgical stages. 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.
What Are The Disadvantages?
Mohs micrographic surgery is performed under local anesthesia so there may be some discomfort from the injections. Also, since the process may involve several surgical stages, the time for this procedure may take several hours and often all day.
Will The Surgery Leave A Scar?
Yes. Most forms of therapy will leave a scar. However, the Mohs micrographic surgical procedure tends to minimize this as much as possible. After the wound is healed you may wish to have the scar improved. Generally, time alone will improve all scars. Any scar may be further touched up and improved with a variety of techniques, such as injections, sanding (dermabrasion), laser, or further surgery. Remember, all scars improve with time.
Will I Develop More Skin Cancers?
After having one skin cancer, statistics say that you have a higher chance of developing a second one (50% of a second in the next 5 years). The damage that your skin has already received from the sun cannot be reversed. However, there are precautions, such as protecting yourself from excessive sun exposure that can be taken to prevent further skin cancers. Routine skin checks with your family doctor or dermatologist can also help to catch and treat skin cancers early.
You may experience discomfort at the surgery site. Due to its potential to cause bleeding, we request that you do not take aspirin, but rather use Tylenol. A stronger pain reliever may be prescribed for you.
A small number of patients will experience some bleeding post-operatively. This bleeding can usually be controlled by the use of pressure. Apply constant pressure over the bleeding point for 15 minutes; do not lift up or relieve the pressure at all during that period of time. If bleeding persists, repeat the pressure for another 15 minutes. If this fails, call our office or visit a local Emergency Room. It is advisable not to drink alcohol the first postoperative night as this may stimulate bleeding.
A small red area may develop surrounding your wound. This is normal and does not necessarily indicate infection. However, if this redness persists or worsens, or the wound begins to drain pus, you should notify the nursing station at Edmonton Dermatology and Skin Surgery Centre at 780-450-7269.
Itching and redness around the wound, especially in areas where adhesive tape has been applied may indicate an allergic reaction. Similarly, you may react to the antibiotic ointment applied to the wound.
Swelling and Bruising
Swelling and bruising can occur after Mohs surgery, particularly when it is performed around the eyes. This usually subsides within 5-7 days after surgery and may be decreased by the use of an ice pack in the first 48 hours.
At times, the area surrounding your operative site will be numb to the touch. This area of anesthesia (numbness) may persist for several months or longer. In some instances, it may be permanent. If this occurs, please discuss it with your physician at your follow-up visit.
What Can I Expect After The Surgery Is Complete?
❑ Together with your doctor, a decision will be made about how and if your wound will be sutured.
❑ Either way, you will be given instructions on how to look after your wound which includes daily dressing changes.
❑ If sutures were used to close your wound, you will be told when to have them removed.
❑ You may be given a course of antibiotics to help prevent an infection.
❑ Medications may be given to help control discomfort after the procedure.
❑ We look forward to seeing you after your procedure for a routine checkup to make sure you have healed properly and that there are no signs of the cancer coming back.