More than one million skin cancers are diagnosed annually. Of these, the most common is basal cell carcinoma followed by squamous cell carcinoma then melanoma.
One in five Americans will develop skin cancer in the course of a lifetime. Sun exposure is the main cause of skin cancer. In fact, a history of sunburns increases one’s risk of developing skin cancer.
Are skin cancers life-threatening?
Melanoma accounts for the majority of deaths due to skin cancer. Basal cell carcinoma is very rarely life threatening. Squamous cell carcinoma is generally not life threatening, except in aggressive disease in high-risk locations or in the setting of immune suppression, such as organ transplant recipients. Basal and squamous cell carcinomas do not turn into melanoma.
What skin cancer treatments are available?
Multiple methods are available to treat skin cancer: freezing with liquid nitrogen, burning with electric current, radiation therapy, topical chemotherapy, and surgical removal. Mohs surgery is best suited for treating skin cancer in critical areas such as the head and neck where maximum preservation of healthy tissue is vital for both cosmetic and functional reconstruction.
What makes Mohs surgery so effective?
While conventional surgical instruments are used to remove malignant tissue during surgery, it is what happens to that tissue after it is removed that makes the procedure so effective. After removing the obvious tumor, a thin layer of normal-appearing skin surrounding the tumor is then carefully removed and meticulously mapped. The specimen is processed in the Mohs laboratory, which takes about an hour. If cancer is present in the tissue upon examination under the microscope, the location is marked on the map and more tissue is removed. This step is repeated, as necessary, until the tumor is completely removed.
A skin cancer may be larger than it appears. Microscopic growths may extend well beyond the visible outline of the tumor. Mohs surgery is specifically designed to treat these skin cancers by mapping and removing microscopic tumor.
What are the advantages of Mohs surgery?
The advantages are two-fold – using the microscopic mapping, the surgeon is better able to remove all the cancerous tissue while preserving as much healthy tissue as possible.
Will there be a scar after surgery?
All surgery results in a scar. The appearance of the scar depends on the size and location of the skin cancer. The priority of Mohs surgery is to remove the skin cancer while preserving as much healthy skin as possible. This allows us to work together in our goal of removing the cancer and minimizing the scar. Through the body’s own healing properties, scars naturally remodel over six to twelve months. If a scar behaves unexpectedly, there may be techniques available to improve its appearance.
Will stitches be used to close the surgical area?
The wound size and location, as well as other factors, determine how your wound will be repaired. There are three basic ways to handle wound reconstruction:
Stitches: In most cases surgical wounds are stitched together from side to side or by rearranging nearby skin. Both absorbable and non-absorbable stitches may be used. Non-absorbable stitches need to be removed at a later date.
Skin Graft: In some instances, it is necessary to remove skin from another site and graft it over the wound using stitches. Skin is borrowed from discrete areas to hide the scar.
Second Intention Healing: The body is allowed to heal the open wound on its own. This takes approximately 3 to 6 weeks depending on the size of the wound. Regular wound care is required.
Will I be awake during surgery?
Yes. Because the surgery takes place over the course of a day, in multiple sessions, local anesthesia is used to eliminate the risk of prolonged general anesthesia. Medication to reduce anxiety is available if needed at the time of surgery.
How long will the procedure take?
Most Mohs surgeries can be completed in three or fewer stages, requiring less than four hours. However, it is not possible to completely predict how extensive a cancer is prior to surgery. Therefore, it is advisable to reserve the entire day for this surgical procedure, in case the removal of additional layers is required. Since much of the time is spent waiting for laboratory results, bring reading materials or other items to pass the time.
What are the potential complications of surgery?
Any procedure can result in complications or adverse events. Bleeding complications and infection are the two primary complications of Mohs surgery. However, both are uncommon.
Will my insurance cover the cost of surgery?
Most insurance policies cover the costs of Mohs surgery and reconstruction of the resultant surgical area. It may be necessary to obtain a referral or authorization from your primary physician or insurance company prior to surgery. Contact your insurance carrier directly for the most current payment information relative to this surgery.
Preparing for Mohs Surgery
Medications: If you are taking prescription medications, continue taking all of them prior to surgery unless otherwise directed by a physician.
Previously, common practice was to discontinue blood-thinning medications prior to Mohs surgery to reduce the risk of bleeding complications after surgery. However, recent studies have shown that the risk of bleeding problems is not significantly increased for patients continuing bloodthinning agents. Bleeding complications are always a risk of surgery, but fortunately are uncommon. More importantly, serious adverse events including stroke, heart attack, and blood clots in patients who discontinue bloodthinning medications have been reported. However, please list all your medications, including blood-thinning medications such as Coumadin, Plavix, aspirin, nonsteroidal anti-inflammatory medications (such as Advil, Motrin, or Naprosyn), vitamin E, gingko, garlic, ginseng, ginger, ephedra or other nutritional supplements.
Antibiotics: Guidelines for antibiotics prior to skin surgery have recently been updated. Please prepare a list of your current medications and allergies and call our office before your surgery appointment if you have any of the following conditions requiring pre-operative antibiotics:
- Orthopedic prosthesis within the past two years
- An artificial heart valve
- History of infective endocarditis
- Congenital heart conditions
- Cardiac transplantation with heart valve problems
- Central nervous system shunts
Recent cataract surgery: Consult with your eye surgeon as to how soon you may undergo Mohs surgery. If your skin cancer is close to the eye, it may be wise to wait a few weeks.
Food: Eat breakfast the morning of surgery. Also bring a snack or lunch for later in the day.
Sleep: It is important that you obtain a good night’s rest prior to surgery.
Clothing: Wear loose, comfortable clothing. Button down shirts are suggested if the treated area is on the torso.
Support and Assistance: It is advisable to arrange for someone to drive you home following surgery. Also, in many instances someone other than the patient must perform postoperative wound care. We will provide written instructions following surgery, demonstrate wound care, and answer any questions you may have. We ask that you not bring children.
After Mohs Surgery
Will I have appointments after surgery?
Post-surgical follow-up visits to inspect the surgical wound or remove stitches may be needed and are generally scheduled about a week after surgery. After these you will return to your referring doctor to resume routine skin cancer examinations.
If you must change an appointment, please call us as soon as possible. This courtesy allows us to schedule another patient for care. Please do not fail to show for an appointment as this can cause delays for other waiting patients.
What should I know about post-surgery?
If there is some discomfort following surgery, normally Tylenol is all that is needed for relief. However, pain medications will be prescribed if needed. You may experience some bruising and swelling around the wound, especially if surgery was performed near the eye area.
Your activity will be restricted after surgery. Do not lift over 10 pounds the first week after surgery and do as little bending over, straining and stooping as possible. Plan to be off work for several days after surgery. Avoid any long trips within the first 10 days following surgery in case complications develop.