Mohs' Micrographic Surgery is a highly specialized method of removing and examining
cancerous tissue to ensure its removal. Frederic Mohs first invented this
procedure, which is now named after him. For the most common forms of skin
cancer (basal cell carcinoma and squamous cell carcinoma), this procedure has
the highest cure rate (least chance of the skin cancer growing back).
Step 1: The area is cleansed with alcohol.
Step 2: The visible tumor is identified and marked (usually with a
purple gentian
violet marking pen)
Step 3: The area is numbed using tiny needles and injecting a local anesthetic
Step 4: The area is prepped (cleansed) using Betadine® or Hibiclens® to reduce the risk of
infection.
Step 5: The tumor itself is often removed using a curette (small sharp tool)
or cut out using a scalpel.
Step 6: A small margin (usually < 1mm) of normal appearing skin is removed all around and
underneath the area where the tumor was. This is called Stage 1.
This skin is used for examination.
Step 7: The skin removed from Step 6 is inked for orientation purposes so
that if there is any cancer remaining, the surgeon can go to the exact location
where it remains to remove more tissue (which would be Stage 2, etc.).
Step 8: The tissue is then frozen and cut and placed onto glass slides that
will be stained.
Step 9: The slides are then examined by the surgeon to ensure that all of the
cancer is out. If the cancer is not all out, the surgeon can locate the
area on the patient where cancer remains by the dyes that were used for
orientation purposes and take an additional stage (see steps 7-9).
Step 10: After all of the cancer is out, the wound can be
left to heal by itself (without stitches) or closed using stitches.
Common misconceptions about Mohs' Surgery:
1. "Mohs' leaves a big scar".
False. Mohs' actually removes
less normal (non-cancerous) tissue than nearly any other surgical modality and usually
results in less scar. Mohs' Surgery is a method used to remove
tumors, it is not a method to repair the resultant defects. A bad outcome
is usually due to one of the following reasons:
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The defect (hole) after the tumor was removed was left to
heal without stitches, when putting stitches in would have been a better option
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The defect (hole) after the tumor was removed was closed with
stitches, but the repair was not as good as it could have been.
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The defect (hole) after the tumor was removed was closed with
stitches, but the area did not heal well for one of many reasons.
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The tumor was in a bad location or was a large tumor that
resulted in significant scar.
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Sometimes, additional surgery or other procedures may be
needed to obtain an optimal cosmetic outcome.
2. "Mohs' surgery costs too much money and is not necessary".
False, in many cases. Several
studies have shown that Mohs' surgery is extremely cost-effective in the
treatment of skin cancers in that it has the lowest recurrence rate (least
chance of the cancer growing back). Mohs' surgery is more costly than some
treatments, but usually costs much less than radiation or surgery that is
performed in a hospital or ambulatory surgery center. Many tumors do not
require Mohs' surgery and discussion with one's doctor or Mohs' Surgeon is
recommended to help choose an appropriate treatment method.
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after the removal of a basal cell carcinoma using Mohs'
Micrographic Surgery |
1 week after Plastic Surgery performed by Dr. Bader |
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| after removal of a basal cell carcinoma using
Mohs' Micrographic Surgery |
Immediately after reconstruction using a skin
flap and full-thickness skin graft performed by Dr. Bader. |
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after removal of a basal cell carcinoma |
immediately & several months after reconstruction using a
skin graft performed by Dr. Bader |
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| after removal of a basal cell carcinoma |
several months later after reconstruction
using a skin and muscle flap (myocutaneous flap) performed by Dr. Bader |
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after removal of a basal cell carcinoma |
1 week after flap repair performed by Dr. Bader |
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