Mohs Surgery

About Mohs Surgery

+What is Mohs surgery?

          Mohs surgery is a highly specialized treatment for the complete removal of skin cancers. It is named after Dr. Frederic Mohs who developed the technique in the 1930s. With this technique, surgically-trained dermatologists remove skin cancers one layer at a time, ensuring all the cancer has been completely removed, while also providing maximal preservation of normal skin.

+What are the advantages of Mohs surgery?

          Mohs surgery offers the highest cure rates for skin cancer, which are usually 95-99%. In contrast, other methods available to treat high-risk skin cancers have cure rates of 50-90%.
          The reason that Mohs surgery is so effective is because it allows for microscopic evaluation of 100% of the surgical margin and allows the surgeon to detect any "roots" of cancer that were left behind. In addition, it is very well tolerated since it is performed using only local anesthesia.

+Why does my skin cancer need Mohs surgery?

          Mohs surgery is used for skin cancers which are at higher risk for forming subclinical extensions or "roots" which are invisible to the eye. These cancers can be much bigger than they look on the surface, much like the tip of an iceberg. Mohs surgery is indicated in the treatment of skin cancers:
          • located on or in close proximity to the nose, eyelids, lips, ears, scalp, hands, or feet
          • that are recurrent (have come back after being treated before)
          • that have aggressive pathology on the biopsy
          • that are large
          • that are rapidly growing
          • that cannot be clearly defined
          • that occur in immunosuppressed patients

+How is Mohs surgery performed?
Step 1: After the area is numb from the local anesthesia, Dr. Thakker removes all visible skin cancer.
Step 2: A 2-3mm margin of normal-appearing skin is excised around the wound bed. After the area is numb, steps I and 2 usually take only 5-10 minutes.
Step 3: The tissue is marked in quadrants, inked, and mapped accordingly by Dr. Thakker.
Step 4: The tissue is frozen and processed in the onsite laboratory; Dr. Thakker evaluates the slides and examines them for any cancer still present at the edges. This step may take a minimum of 60-90 minutes.
Step 5: If skin cancer is still present, the patient is brought back to the surgical suite and more tissue is taken only in the area that still had skin cancer present. This tissue goes to the lab for processing as in step 4. This continues until all of the cancer has been removed.

Preparing for Mohs Surgery

+How long does the surgery take?

          It is impossible to predict how many stages of Mohs surgery a patient will need. Each stage can take 1-2 hours to process, and reconstruction can take an hour or more. Most cancers are cleared in 1-3 stages. Therefore, it is best to not make any other plans for the rest of the day.

+How do I prepare for Mohs surgery?

          Once you have been referred by your provider to our office, please call us to schedule an appointment. If you have never had the Mohs procedure, have multiple medical problems, or have a large tumor, an initial consultation appointment may be beneficial. This appointment is important to evaluate your skin cancer, explain the procedure in detail, and make sure that Dr. Thakker does not need to do any further testing or referrals prior to your surgery. Other things you should do or know prior to your Mohs surgery include:
          • Do NOT stop taking Aspirin, Coumadin, Plavix, or other blood-thinners if these were prescribed by a doctor for medical reasons.
          • Do discontinue the elective (non-physician directed) use of Aspirin (for pain or arthritis), Ibuprofen (Advil, Motrin, Aleve) Vitamin E, and herbal supplements for 10-14 days before the procedure.
          • Avoid alcohol for 48 hours before and 48 hours after the surgery; alcohol causes excessive bleeding. Prepare to be at the office for an entire day on the day of the Mohs surgery - bring a book, computer, or other activities to keep you busy while you are waiting.
          • You may be instructed to have someone drive you home from the surgery, but in most cases you can drive yourself home. The waiting area is limited so please bring no more than one person with you.
Try to get a good night's rest prior to the surgery. Unless instructed otherwise, you are free to eat and drink as usual.

  • Should I have breakfast on the day of surgery?

          We suggest that you eat a normal breakfast unless you have a same day reconstruction appointment with another doctor. In this case, follow the pre-op instructions that he/she gives you.

After Mohs Surgery

+Will I need stitches after Mohs surgery?

          Dr. Thakker will evaluate the wound after all of the cancer has been removed and will discuss her recommendations with you on the best way to proceed to allow for optimal healing. Options include:
          • Healing without stitches (best for small, shallow wounds)
          • Stitching the wound together side-to-side
          • Performing a skin flap or skin graft
          • Referral to another surgical subspecialist such as an oculoplastic/plastic surgeon

+What should I expect after the surgery?

          It is impossible to predict how many stages of Mohs surgery a patient will need. Each stage can take 1-2 hours to process, and reconstruction can take an hour or more. Most cancers are cleared in 1-3 stages. Therefore, it is best to not make any other plans for the rest of the day.
          • Stitches will need to be removed in 5-14 days depending on the location.
          • Bruising, swelling, and mild to moderate discomfort are common for the first few days after surgery.
          • You must rest to heal properly. No exercise or heavy lifting will be allowed for at least one to two weeks after your surgery.
          • You may need to take time off from work after the surgery, if your job requires physical labor. The staff will provide detailed, written, instructions on how to care for the wound.

If you need Mohs surgery, Contact Us today or call 732-739-3223 to schedule a consultation with Dr. Priya Thakker. Together, you can discuss your concerns and determine whether Mohs surgery is appropriate for you.

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