Your wound is bandaged temporarily and you can relax while the lab work begins. The surgeon cuts the tissue into sections, color codes them with dyes and draws a map of the surgical site.
In the lab, a technician freezes the divided tissue, then cuts very thin horizontal slices like a layer cake. The slices are placed on microscope slides, stained and covered. This meticulous process takes time.
Using a microscope, the surgeon examines all the edges and underside of the tissue on the slides and, if any cancer cells remain, marks their location on the map. The physician then lets you know whether you need another layer of tissue removed. Back in the operating room, the surgeon injects more anesthesia if needed and removes another layer of skin, precisely where the cancer cells remain, based on the map.
Then, while you wait, the lab work begins again. This entire process is repeated as many times as needed until there are no more cancer cells. Once the site is clear of all cancer cells, the wound may be left open to heal or the surgeon may close it with stitches.
This depends on its size and location. In some cases, a wound may need reconstruction with a skin flap, where neighboring tissue is moved into the wound, or possibly a skin graft. In some cases, your Mohs surgeon may coordinate the repair of your wound with another specialist such as a plastic surgeon, oculoplastic surgeon or hand surgeon.
In most instances, however, the Mohs surgeon will repair the wound immediately after obtaining clear margins. The surgery results are precise. The physician examines percent of tumor margins, while sparing healthy tissue and leaving the smallest scar possible. Mohs offers the highest skin cancer cure rate : up to 99 percent for a skin cancer that has not been treated before, and up to 94 percent for a skin cancer that has recurred after previous treatment.
If you have been diagnosed with skin cancer, there is a good chance you will develop more skin cancers. Early detection is key for the best outcome. The surgeon then takes this tissue to the laboratory for analysis. This portion of the procedure typically takes the longest amount of time.
Expect to wait about an hour or so in a waiting room for the surgeon to return. It may help to bring a book or magazine to pass the time. You'll be able to use the restroom or have a snack, if you need to, but you won't be able to leave the surgeon's office until the procedure is complete. While you're waiting, the surgeon or technician cuts the tissue sample into sections and examines them with a microscope. Your surgeon takes great care to keep track of the exact spot where each piece of tissue was removed by making a map.
That way, if a small area of cancer is found in one piece of tissue, the surgeon knows precisely where to continue with the surgery. If cancer remains, your Mohs surgery will continue. Your surgeon removes an additional layer of tissue from the affected area, taking care to remove tissue that contains cancer while leaving as much healthy tissue as possible intact. Again, you'll wait while the surgeon examines the tissue in the laboratory. The process is repeated until the last tissue sample removed is cancer-free.
Local anesthetic can be re-administered as necessary. After all of the cancer has been removed, you and your surgeon can decide on how to repair the wound. Depending on the extent of the operation, this might include:. If the surgical area is extensive or complex, your surgeon may temporarily close your wound and then refer you to another surgeon for reconstructive surgery to repair the wound. One of the advantages of Mohs surgery is that you know your results right away, and you usually don't leave your appointment until all of the skin cancer has been removed.
You may have a follow-up visit with your surgeon or referring doctor to monitor your recovery to make sure your wound is healing properly. The Mohs surgeon removes the skin cancer that can be seen with the naked eye and takes it to a laboratory nearby.
After the laboratory makes microscope slides with the removed skin cancer tissue, the Mohs surgeon looks under the microscope to check for any cancer cells left along the edges of the tissue. The microscope can help the surgeon find cancer that is small, hidden, or deep under the skin.
If more cancer is found, the surgeon then removes more tissue along the sides or deep edge where the cancer is still present. This tissue is again processed by the laboratory and rechecked under the microscope by the Mohs surgeon.
The process continues until all of the cancer is cut out. Because it is not possible to know how many tries it will take to remove the entire tumor, patients should be prepared to be at the dermatology clinic or medical center for the entire day. However, most procedures take just a few hours Video. After all of the cancer is removed, the Mohs surgeon will talk with the patient about different ways to fix the wound.
The wound can be left to heal on its own, can be stitched closed in a straight line, or may require a more complicated surgical procedure. Often the wound is closed the same day by the Mohs surgeon, but sometimes it is repaired by another surgeon on the same day or a different day. The surgeon who fixes the wound provides instructions on how to take care of it at home.
Published Online: May 6, Conflict of Interest Disclosures: No conflict of interest disclosures were reported. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
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