Mohs Surgery: A Highly Effective Treatment for Skin Cancer
Medically reviewed by Susan Bard, MDMedically reviewed by Susan Bard, MD
Mohs surgery is a form of skin cancer treatment. It involves surgically removing thin layers of skin, examining each layer for signs of cancer, and then continuing the process until no cancer cells are detected in the layers. The primary goal of Mohs surgery is to remove all skin affected by cancer while allowing the surrounding skin to remain intact and undamaged.
While other skin cancer treatments are available, Mohs surgery is considered the gold standard because of its top-line efficacy against two forms of skin cancer: basal cell carcinoma and squamous cell carcinoma. It can also be used to treat other forms of skin cancer.
This article discusses how Mohs surgery works, its benefits and risks, recovery from it, and success rates.
Ugur Karakoc / Getty Images
Should I Get Mohs Surgery?
Choosing the right cancer treatment is a personal decision. Your healthcare provider will walk you through all of your options and allow you to weigh the risks and benefits of each before deciding on one.
That said, if you have basal cell carcinoma or squamous cell carcinoma or are worried about cancer recurrence, Mohs surgery may be the best form of treatment for you. It’s also a good option for those looking for minimal scarring, less damage to the skin surrounding the area, and those who do not want to do more invasive treatments.
Mohs Surgery Cure Rate
According to the Skin Cancer Foundation, Mohs surgery offers a 99% cure rate for skin cancer that has not yet been treated using other methods.
Learn More: Mohs Surgery Pictures: Before and After Skin Reconstruction
How Mohs Surgery Works
Mohs surgery is considered a less invasive option for skin cancer. The procedure is performed in one visit but in stages. The process is as follows:
Exam and prep: A Mohs surgeon examines the area where skin cancer cells are found and marks it for reference. They position you so that they have the best access to the area for the procedure, and they put a surgical drape on the area. Local anesthesia numbs the area for the procedure, but the patient is awake the entire time.
First stage removal: The Mohs surgeon removes a thin layer of cancerous tissue during the first stage removal using a scalpel. The goal of the first stage (as with every stage) is to remove the entire tumor.
Lab analysis: When the tissue is cut out, it is color-coded with dye, the surgical site is mapped out, and the sample is sent to the lab to be frozen.
Microscopic examination: After the tissue samples are ready, they are put onto a slide and examined under a microscope to check for remaining cancer cells. The location on the map is also marked. If necessary, another layer of tissue will be taken using the same process.
Wound repair: After the final layer of tissue is removed (the one that determines all of the cancer has been cut away), the wound may be left open or closed to heal depending on the size and where it is located on the body. In some cases of more extensive wounds, a skin flap or graft consisting of surrounding tissue will be moved to the wound.
Finishing the process: After the wound has been treated, you will receive instructions on wound care, scar care, and follow-up appointments. The entire process can take several hours to complete.
Why Is Mohs Surgery So Effective?
Mohs surgery is so effective because the process is localized, removes all cancer cells meticulously, and allows a person to keep as much healthy surrounding tissue as possible.
Conditions Treated With Mohs Surgery
Mohs surgery is typically recommended for people with basal cell carcinoma or squamous cell carcinoma. These cancers are rarely fatal because they grow slowly and don’t typically spread or spread so slowly that they are often caught early.
When it comes to both cancers, Mohs surgery is typically recommended if:
The cancer is aggressive, or the area affected is large.
It appears in an area with thinner or fewer layers of skin with little tissue underneath, such as the nose, ear, scalp, genitals, hands, feet, or eyelids.
The person has a compromised or suppressed immune system.
It was already treated but recurred.
In some cases, Mohs surgery can also treat other forms of skin cancer. For example, a specific type of melanoma known as lentigo malignant melanoma or melanoma in situ can be treated using Mohs surgery if it is caught early enough.
Rare skin cancers, such as extramammary Paget’s disease, Merkel cell carcinoma, and dermatofibrosarcoma protuberans (DFSP) can also be treated using Mohs surgery in some cases.
Deciding to Use Mohs Surgery
Medical providers will assess the cancer, location, and aggressiveness to determine when to use Mohs. Though it is a first-line treatment, it is not recommended for all cases.
Learn More: Purpose of Mohs Surgery
Benefits and Risks of Mohs Surgery
There are various advantages to taking the Mohs surgery route for treating skin cancer. The benefits include:
Complete removal of all cancer cells.
High cure rate.
Removing the exact tissue as opposed to just estimating.
Leaving as much healthy tissue behind to reduce scarring and improve cosmetic outcomes.
It is a one-day operation, allowing the patient to spend less time in treatment.
It can, in some cases, permanently cure skin cancer when other treatments have failed.
One of the biggest disadvantages of Mohs surgery is that it isn’t as effective for other forms of skin cancer, such as some forms of melanoma. As is the case with all types of surgery, there are some potential risks and complications. Though Mohs surgery is considered exceptionally safe, some possible adverse events can develop, including:
Infections
Impaired wound healing
Bleeding
Nerve injury that can lead to functional loss of feeling in the area
Scarring if the area needed a more extensive removal of skin
Preparing for Mohs Surgery
A person must do various things to prepare for Mohs surgery. Each precaution is taken at a set time before the procedure:
Two Weeks Prior to Surgery
Two weeks before your scheduled Mohs surgery, you will be asked to stop smoking because it can interfere with the way the wound heals following the procedure. You will also be asked to avoid certain medications that may increase the risk of excessive bleeding, including:
Aspirin or products that have Aspirin in them
Nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen
One Week Prior to Surgery
The week before surgery, you will have to prepare by eliminating certain products from your lifestyle that could cause an increased risk of raised blood pressure and increased bleeding. Those products include:
Garlic
Vitamins E and C
Fish oil
Other herbal supplements as recommended by your healthcare provider
24 Hours Prior to Surgery
On the day of surgery and in the 24 hours before it, you should avoid consuming alcohol of any kind. It can cause an increase in blood pressure and a higher risk of bleeding.
Day of Surgery
When the day of surgery arrives, you should do several things to ensure that you are well-prepared for the best possible outcome. They include:
Taking a shower or bath to ensure that all surgical areas are cleansed and ready for the procedure
Avoiding applying any makeup, lotions, or other products to the surgical area
Taking all scheduled and prescribed medications (unless your healthcare provider directs you otherwise) and bringing a list of your medications to the appointment with you
Eating normally
Wearing comfortable and loose-fitting clothing
Bringing a newspaper, book, and/or snacks to help pass the time because the procedure can run for up to four hours
Though you won’t go under general anesthesia, you may also want to bring a relative or friend with you to keep you company and for moral support.
Preparing the Skin for Mohs Surgery
Though your surgeon and the surgical team will ensure that the area is thoroughly cleansed beforehand, you should also shower and clean the area on the day of your surgery. Also, avoid adding any lotions or creams to the site.
Related: What Happens During Post-Mohs Reconstructive Surgery
Recovery and Aftercare
After the procedure is complete, there may be a repair process to close and care for the wound. It will include reconstruction options, such as a skin flap, to ensure the wound closes and heals effectively with minimal scarring. Typically, the fewer layers of skin that need to be removed, the less likely a person will require reconstruction.
The surgical team will also provide at-home care instructions to ensure you heal properly and avoid complications like infection. They include:
When to change bandages
When and how to clean the wound
What medications to take to alleviate pain
The timeline in which you can return to normal activities
A schedule of follow-up appointments to monitor healing
Scar treatment recommendations
These recommendations are not set in stone because each person is different, and their experience with Mohs surgery will vary significantly. Because healing is unique to the individual, the guidelines on aftercare will be too. That said, some general tips on aftercare include:
Avoid bending, heavy lifting, rigorous exercise, or exertion.
Be prepared for routine swelling and bruising that will typically reduce within five to seven days.
Watch for signs of infection as the wound heals.
Practice patience because the wound can take months to heal completely.
Learn about the signs of skin cancer so you can recognize them if the cancer recurs.
Minimizing Scarring After Mohs Surgery
Ensuring that your scar is as unnoticeable as possible requires that you:
Stay out of the sun until the wound has fully healed.
Use moisturizers approved by your surgeon on the area to massage the skin and reduce scar formation.
Use scar-reducing creams or gels that contain silicone.
Maintain a healthy diet and stay hydrated.
Learn More: Mohs Surgery: Recovery
Can the Cancer Come Back?
Mohs surgery is highly effective and can cure skin cancer in up to 99% of cases. However, the cancer can come back in the same area.
Research shows that the recurrence rate for those with basal cell carcinoma and squamous cell carcinoma is roughly 1.3 per 100 person-years and 4.5 per 100 person-years, respectively.
Risk Factors for Recurrence
While recurrence can happen in anyone, there are several risk factors associated with a higher rate of the cancer returning. They include:
Age
Non-primary tumors
Immunosuppression
Success Rates and Follow-Up Care
Mohs surgery is a highly successful procedure with a cure rate of 99%. The cosmetic appearance following surgery is also better than other forms of treatment, with many people developing minimal scarring while keeping the healthy surrounding tissue intact.
Importance of Regular Follow-Ups
According to the Skin Cancer Foundation, as many as 60% of people who develop skin cancer will be diagnosed with a second form of it within a decade. Because of that, scheduling and attending regular follow-up appointments and skin cancer screenings is vital to ensure that if you do develop skin cancer again, it can be caught early and cured or effectively treated.
Alternative Treatments for Skin Cancer
Some nonsurgical treatments for skin cancer include:
Photodynamic therapy (PDT): Shines blue fluorescent light onto a topical medicine applied to the skin to kill abnormal cells.
Imiquimod: A topical prescription cream that can treat actinic keratoses.
Fluorouracil: A topical prescription cream that can treat actinic keratoses and basal cell carcinoma.
Alternative treatments may be helpful in treating skin cancer, but none offer the same efficacy as Mohs surgery. Little clinical evidence supports that many alternative therapies, especially herbal and botanical solutions, do much in the way of treating skin cancer.
When deciding between Mohs surgery and other treatment methods, weighing your options is crucial.
Talking to Your Healthcare Team
When deciding whether Mohs surgery is right for you, it’s crucial to be upfront and honest with your healthcare team about your desired results and fears. They will help provide you with alternative options to consider and the benefits and drawbacks associated with Mohs surgery to ensure that you make the most informed and best decision for you.
Summary
Mohs surgery is a minimally invasive form of skin cancer treatment with a 99% success rate. Because it is so highly effective at curing certain skin cancers, namely basal cell carcinoma and squamous cell carcinoma, it’s considered the gold standard of care.
People with other cancers, such as melanoma or other rare forms, may or may not be candidates for Mohs surgery, depending on the type and case. Because there are few side effects and the promise of minimal scarring following Mohs surgery, many people opt for the procedure over other forms of care to cure their skin cancer.
Before making any decisions, speaking to a healthcare provider about Mohs surgery and whether it's right for you is essential. They will walk you through the procedure and allow you to make an informed decision regarding your care.
Read the original article on Verywell Health.
