Mohs Surgery
Mohs surgery is an operative technique for treating skin cancer that involves surgically removing only the skin cancer area and a thin margin surrounding the lesion, layer by layer, and sending them to the laboratory for examination under a microscope. If the test results show skin cancer, the dermatologic surgeon will repeat the surgery on deeper layers of the skin and send it for further testing until no cancer is found. Mohs surgery is a surgical technique that can remove whole skin cancer cells, help preserve healthy skin tissue as much as possible, and is considered the skin cancer treatment that has the highest cure rate available.
Why Mohs Surgery?
In the past, surgeons treated skin cancers through excision surgeries by vertically removing only the cancerous specimen in a wide margin using the breadloafing technique without diagnosing the extent of the horizontal spread into nearby tissues beneath the epidermis, as well as the margin and outside of the specimen that cannot be seen through the epidermis. These surgeries often resulted in large incisions and may not have eradicated all cancer cells in a single procedure, leading to a potential skin cancer recurrence.
Later, Dr. Fredric E. Mohs, an American surgeon, invented the Mohs Micrographic Surgery (MMS) technique to treat skin cancer, which involves cutting the tissue and peripheral rim in both horizontal and vertical directions circumferentially and sectioning the tissue into a thin layer to facilitate tissue processing. The specimen is then taken to a pathology laboratory and examined for skin cancer under a microscope. If the results show a cancer cell, the dermatologic surgeon will repeat the skin surgery procedure on the deeper layers until the microscopic examinations are negative or no cancer cells remain. This surgical method effectively inhibits the spread of cancer cells, treats early-stage skin cancer, and cures skin cancer by up to 99% with minimal disfigurement. In addition, if the dermatologic surgeon finds the cancer cells have spread to other organs, he or she will determine additional treatment options such as medication, chemotherapy, or radiation to treat cancer.
What causes skin cancer?
Skin cancer is caused by genetic and environmental factors, as follows:
- Long-term, frequent exposure to sunlight and ultraviolet radiation (UVA and UVB).
- Some chemicals, such as arsenic, contaminate drinking water.
- Have a history of radiation therapy.
- Immunocompromised or low immunity, such as HIV infection or organ transplantation.
- Long-term use of immune-suppressing drugs.
- Burn scars or scalds that progress to cancer.
- Have a family history of skin cancer.
- Those with pale white skin or albinism.
What diseases can Mohs surgery treat?
- Basal cell carcinomas (BCCs)
- Squamous cell carcinomas (SCCs)
- Melanoma (MM)
- Other skin malignancies such as:
- Dermatofibrosarcoma protuberans (DFSP)
- Cutaneous lymphomas
- Merkel cell carcinoma (MCC)
Skin cancer features and symptoms treatable with Mohs surgery
- Skin cancer near the eyes, nose, mouth, ears, scalp, or genitals.
- Early-stage skin cancer
- Reoccurring skin cancer
- Skin cancer grows and spreads rapidly and aggressively.
- Skin cancer without a clear edge.
- Skin cancer that grows on the scar
- Skin cancer has not been completely eradicated after previous conventional surgery.
Who should be treated by Mohs surgery?
- Those who have a rash, bump, or lump on their skin that has changed size or shape.
- Those who have a new rash, bump, or lump on their skin that does not go away in 4-6 weeks.
- Those who have a rash, bump, or hard lump on rough skin or a firm, rough, scaly wart-like scar.
- Those who have pink or red skin nodules, a smooth, shiny surface, and radiating capillaries.
- Those who have a pink, red, or hard bump that may be scaly or bleed on top and gradually enlarge.
- Those who have a mole, birthmark, or freckle that rapidly grows and changes color, size, or shape.
- Those who have an itchy mole, birthmark, or freckle associated with skin fissuring and bleeding.
- Those who have a mole, birthmark, or freckle on their head, face, eyes, ears, nose, throat, fingers, toes, or genitals.
- Those who have chronic non-healing wounds lasting more than 4 weeks.
What is the diagnosis before Mohs surgery?
The dermatologist will diagnose skin cancer by inquiring about symptoms and physically inspecting areas where bumps, lumps, moles, birthmarks, or abnormal skin and surrounding tissue appear, along with taking a medical history as follows:
Medical history
- Inquiring about when abnormal skin first appeared, the growth rate, the color, size, shape, symptoms, and whether or not blood was oozing.
- Medical history, congenital diseases, medications, and dietary supplements are taken regularly.
- Family history of skin cancer
- Profession, regular activity, lifestyle, or way of living.
Skin biopsy
The dermatologist will take a sample of abnormal skin tissue and send it to a laboratory for pathological examination to determine whether the biopsy is cancerous, including the type and stage of cancer.
Treatment Options
The dermatologist will inform the patient of the diagnostic test results and explain treatment options, including medication and/or combination therapy, as follows:
- Curettage and electrodesiccation: mostly for lesions smaller than 2 centimeters, to eliminate cancerous cells.
- Liquid nitrogen cryotherapy: To eliminate cancer cell division and promote new skin growth.
- Mohs surgery (Mohs Micrographic Surgery: MMS): surgical removal of the cancerous skin and layer-by-layer excision of tissue margin surrounding the lesion, then sent for microscopic examination until no cancer cells are found.
What is Mohs surgery procedure at MedPark Hospital?
Mohs Surgery (Mohs Micrographic Surgery: MMS) at MedPark Hospital is performed using gold standards in diagnosing and treating skin cancers using the Mohs surgery technique by dermatologic surgeons with specialized training and best practices, prioritizing the utmost safety and treatment effectiveness. The surgery will be completed within 1 day, and the patient will be able to return home without having to stay in the hospital overnight for recovery.
Pre Mohs Surgery Preparations
A week before the surgery, the dermatologist will ask the patient to stop taking certain medications, particularly antiplatelet drugs including aspirin, ibuprofen, naproxen, or Plavix.
• Individuals with congenital disease, those taking medication for an underlying disease, and those wearing pacemakers must notify the dermatologist in advance.
• Refrain from drinking alcohol the day before and the day of surgery.
• Eat easily digestible foods the day before and on the day of surgery.
• Get enough sleep the night before surgery.
During Mohs Surgery Procedures
- Before the surgery, the medical staff explains the Mohs surgery procedure for treating skin cancer and obtains consent forms.
- For some patients, the dermatologist may consider administering antibiotics prior to surgery.
The nurse cleans and disinfects the surgical field to prevent infection. - The dermatologic surgeon performs a mapping procedure by marking the skin cancer area, peripheral margins, and surrounding lesion of the removed skin in all dimensions, left to right and top to bottom.
- The dermatologic surgeon infiltrates local anesthesia into the marked skin cancer area, peripheral margins, and surrounding lesion to numb the skin removal area.
- The dermatologic surgeon performs a Mohs surgery by cutting the skin cancer, including the visible portion, peripheral margins, and surrounding lesion, in both horizontal and vertical directions circumferentially at a 45-degree bevel according to the marked size and shape, considering preserving as much healthy skin tissue as possible.
- The dermatologic surgeon immediately took a sample of the sectioning tissue (specimen) and sent it to a medical laboratory for pathology examination, where the pathologist will perform the margin assessment, which will take approximately 1 hour, depending on the pathology of each individual's tissue.
- The pathologist will meticulously examine the incision margin, including the bottom and peripheral margins of the removed tissue layer, using a microscope.
- If the specimen examination results confirm skin cancer, the dermatologic surgeon will repeat the skin surgery procedure on the deeper layers and send them for laboratory testing until the test results are negative or no cancer cells are found in the lesion area.
- After completing treatment, the dermatologic surgeon will consider wound reconstruction options such as stitching the wound, skin grafting, or closing the wound with adhesive skin tape to allow the wound to heal naturally without stitches. Wound management is determined by the size, width, depth, and location of each individual's wound.
Post Mohs Surgery Procedures
- If the wound is not closed with stitches, avoid exposure to water for 24 hours after surgery. Clean the wound with normal saline and dry it thoroughly to prevent infection and speed up the healing process. Then, apply antibiotics as directed by the dermatologist in the morning and evening.
- If the wound is closed with stitches, avoid exposure to the water until the day of stitch removal. If the wound or dressing is wet, gently remove the dressing, dry the wound, and replace it with a new dressing.
- If the wound is bleeding, apply pressure to the wound with a clean cloth for 20 minutes to stop the bleeding. If the bleeding does not stop, see a dermatologic surgeon for an examination.
- If there are any unusual symptoms in the wound, such as excessive bleeding, swelling, pain, or oozing pus, consult a dermatologist.
- If the pain is severe, take pain relievers as prescribed by the dermatologist every 4-6 hours, except aspirin.
- Visit the dermatologist at each appointment to assess treatment outcomes. In addition, the dermatologist will schedule annual follow-up appointments to ensure the cancer does not reoccur.
- If you notice a rash, bump, lump, mole, stigma, or abnormality on the treated lesion, see a dermatologist right away to have your symptoms checked.
What is Mohs surgery aftercare?
- Apply sunscreen with an SPF of 30 or higher for 20–30 minutes each day, reapplying every 2 hours to protect against UVA and UVB rays.
- Avoid exposure to sunlight, particularly between 9:00 a.m. and 5:00 p.m., as this may be a trigger for skin cancer recurrence.
- Wear clothing that completely protects your skin from the sun; use a hat or an umbrella to avoid direct sunlight.
- Stop smoking and avoid dust, toxic pollution, and secondhand smoke.
- Eat vegetables, fruits, and antioxidant-rich foods; get enough sleep; and exercise regularly.
- Always observe your skin regularly. If abnormalities are found, see a dermatologist right away.
What is the risk associated with Mohs surgery?
Risks associated with Mohs surgery include excessive bleeding, hematoma, swelling, bruising under the skin, wound pain, or infection. However, compared to the highest cure rate, skin cancer treatment with Mohs surgery is considered a very effective method of treating skin cancer that is highly safe and greatly reduces the chance of recurrence.
What are the benefits of Mohs surgery (MMS)?
- The highest cure rate for skin cancer is up to 99% for those diagnosed for the first time.
- The highest cure rate for skin cancer is up to 94% in those with recurrent skin cancer.
- Successful skin cancer treatment for basal cells, squamous cells, certain types of melanomas, and nonmelanoma skin cancer.
- Successful skin cancer surgery targets sensitive areas such as the face, eyes, ears, nose, throat, fingers, toes, and genitals.
- Uses a minimally invasive surgery (MIS) technique: a small incision, less painful, heals quickly, and leaves the smallest scar possible.
- Preserves the greatest amount of natural, healthy skin tissue.
- Reduces the rate of skin cancer recurrence at most.
- Minimal downtime: the surgery takes only 5-10 minutes per round, with a one-hour wait for the biopsy results.
- Time-efficient: the surgery concludes within a day, without the need to stay in the hospital overnight for recovery.
Mohs surgery at MedPark Hospital
Medpark Hospital’s Dermatology and Aesthetic Clinic, Hair Center, led by a team of experienced dermatologists and dermatologic surgeons who are ready to diagnose and treat all types of difficult and complex skin cancers using Mohs surgery and other cutting-edge methods combined with state-of-the-art medical technology and equipment integrated with advanced specialized surgical techniques, ensure fast, accurate, and safe treatment, effectively reducing the risk of cancer recurrence while also providing post-treatment follow-up to lessen complications, speed up wound healing, and increase the chance to be cured of skin cancer permanently.
Clinical Pathology Lab at MedPark Hospital
MedPark Hospital’s Clinical Pathology Laboratory is a medical laboratory certified to ISO 15189 and ISO 15190 standards, led by a team of experienced medical scientists equipped with leading-edge international standards for medical instruments and technology. The Clinical Pathology Lab enables accurate, fast, and precise biopsy analysis, reduces waiting time for results, allows patients to receive biopsy results quickly without the need for referrals to other laboratories, expedites the diagnosis and prognosis process, and assists physicians in effectively planning treatment strategies and quickly tailoring an efficient treatment plan.
