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Louisville, KY 40205
502/896-6355
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Patient Information
MOHS
MICROGRAPHIC SURGERY
WHAT FIRST? KNOW THE FACTS!
Skin Cancer May be More than Meets the Eye
Not all treatments for skin cancer are equal. Options range from common treatments such as scraping, burning & freezing, to radiation excisions, and Mohs surgery. You should be aware of the benefits and drawbacks of various options and choose a treatment that will remove all the cancer, minimize the risk or recurrence, and leave as little scarring as possible. When considering options it is important to recognize that the tumor that is visible to you - even to your physician - may be just the “tip of the iceberg.” Not all cancer cells are apparent to the naked eye. Many “invisible” cells may form roots or “fingers” of diseased tissue that can extend beyond the boundaries of the visible cancer. If these cancer cells are not completely removed, they can lead to regrowth and recurrence of the tumor.
For these cancers, common treatment methods are often not successful because they rely on the human eye to determine the extent of the cancer. These methods can remove too little cancer, which could cause it to recur and require additional surgery, or too much healthy tissue, which could cause unnecessary scarring.
WHAT NEXT? PUT YOUR MIND AT EASE!
Mohs Micrographic Surgery is Advanced Treatment that Gets the Job Done
WHAT IS IT?
Mohs Micrographic surgery (named after Dr. F. Mohs) refers to the surgical removal of skin cancer using microscopic examination to ensure, as much as possible, that the cancer is completely removed. The Mohs Surgeon can directly compare what he sees in the patients skin and under the microscope.
Of all treatments for skin cancer, Mohs Micrographic surgery:
■offers the highest cure rate (up to 99%) (based on data for treating basal and squamous cell carcinomas)
■has the lowest chance of regrowth
■minimizes the potential for scarring or disfigurement
■is the most exact and precise means of removal.
WHEN IS IT DONE?
Mohs Micrographic surgery is not done as a routine procedure. For most routine skin cancers, simple cutting out or scraping is done. The patients who come for Mohs Micrographic surgery have been selected out as having unusual or more difficult tumors because of their type, size, location, or failure of other techniques to produce a cure.
HOW DOES IT WORK?
Your procedure begins in the morning. The skin and tissue around the obvious cancer is removed with a scalpel. This tissue is divided into smaller specimens which are prepared for examination. A color coded map of the cancer site is made, showing the relationship of the specimen which are then viewed under the microscope. During this preparation of specimens for microscopic examination, a bandage is applied and you await the results in the waiting room (usually one-half to one and one-half hours).
The doctor studies the specimens for the presence of cancer at the edges. You then return to the operating area where any area of remaining cancer is cut out exactly as before. The process is repeated until no residual cancer can be found. Because no guess work is involved in determining where the cancer’s edge lies, a minimum of normal skin is removed and only those normal structures involved with cancer are sacrificed. This procedure results in the smallest possible tissue defect and therefore the smallest possible scar. The smaller the wound, the greater the chances for a good cosmetic result after the wound has completely healed.
HOW LONG WILL IT TAKE?
Cancers may be present in skin, fat, muscle and less frequently nerves, arteries, cartilage and bone. In more difficult cases more time is required to remove all the cancer. It is not uncommon to stay for several hours. Some patients will require less time, and some more. You should plan no other activities for the day. Remember, a large portion of the time spent is waiting while your cancer is examined in the laboratory.
WHAT HAPPENS ONCE THE CANCER IS REMOVED?
Once the skin cancer is removed, the area of removed tissue is attended to. In most cases, the surgery to stitch up the wound is done following the excision and you return home the same day. In larger or more difficult cases, arrangements may be made for any of the following: Referral to another specialist for the reconstruction, or surgery requiring a general anesthetic. Depending on your health status and the complexity of the wound closure, the repair may require out-patient surgery a hospital with more anesthesia than was needed for the Mohs surgery. Scheduling the procedure on short notice means there may be limited convenient scheduling options. The plastic surgeons will do their best to schedule the surgery as soon as possible, trying to minimize any inconvenience to you.
WILL THE SURGERY LEAVE A SCAR?
Yes. Scarring occurs after every surgery, but because Mohs surgery removes only damaged tissues, scarring is kept to a minimum.
SURGERY FOLLOW UP.
The Mohs surgeon will follow-up the patient until healed satisfactorily. After that time periodic visits to your referring dermatologist are recommended to check on your progress and treat any possible cancer as soon as possible. Research has shown that if there is a recurrence of cancer, it usually will be within the first year following surgery. One of five patients with one skin cancer will develop another within five years, so follow-up is extremely important for early detection of any new lesion.
PATIENT’S LIFESTYLE FOLLOWING SURGERY.
Once a patient has been given a clean bill of health, he or she should be able to live a normal healthy lifestyle. However, direct sunlight should be avoided. If exposure to the sun is unavoidable, a broad spectrum sun screen* should be liberally applied to all exposed skin, including the top of the ears.
*Dermatology Associates Cosmetic Skin Care Center has several types of broad- spectrum sun screens available.