Mohs Micrographic Surgery
- What is Mohs Micrographic Surgery?
- Special Qualifications of the Mohs Surgeon
- Advantages of the Mohs Surgical Procedure
- Special Indications for Mohs Surgery
- The Mohs Surgical Procedure
- Insurance Coverage for Mohs Surgery
- Patient Preparation for Surgery
- Duration of Procedure
- Minor Post-Surgical Discomfort Expected
- Options for Post-Surgical Reconstruction
- Wound Healing, Scarring, and Scar Revision
- Potential Complications Associated With Mohs Surgery
- About the American Society for Mohs Surgery
Insurance Coverage for Mohs Surgery
Most insurance policies cover the costs of Mohs surgery and the reconstruction of the resultant surgical defect. Please contact the billing department of your Mohs surgeon’s office if you have questions about insurance coverage or to see if your insurer requires you to have a referral from your primary care physician. You may need to contact your insurance company directly about benefits or coverage.
Patient Preparation for Surgery
You should provide your physician with a complete list of all medications (prescription, over-the-counter, vitamins and supplements). This is especially true regarding blood thinners, including aspirin, aspirin substitutes, herbal medicines and supplements. Your doctor may have other preoperative instructions. Pay special attention to these. Additionally, Mohs surgery on some areas may impair your ability to safely operate a motor vehicle. Discuss this with your doctor or his representative before your surgery.
Duration of Procedure
Most Mohs cases can be completed in three or fewer stages, requiring less than four hours. However, it is not possible to predict how extensive a cancer will be, as the extent of a skin cancer’s “roots” cannot be estimated in advance. Therefore, it is advisable to reserve the entire day for this surgical procedure, in case the removal of additional layers is required.
Minor Post-Surgical Discomfort Expected
Most patients do not complain of significant pain. If there is some discomfort, normally only Tylenol is required for relief. However, stronger pain medications are available and may be prescribed when needed. You may experience bruising, swelling and small amounts of bleeding around the wound. If any of these are severe, you should contact your surgeon.
Options for Post-Surgical Reconstruction
After the skin cancer has been removed, your Mohs surgeon will consider various repair options. These may include:
- Allowing the wound to heal without any additional surgical repair (“healing by secondary intention”).
- Wound repair performed by the Mohs surgeon.
- Repair by the original referring physician.
- Repair by another surgeon who might have a particular expertise regarding an anatomic area, repair type, special equipment, or skill regarding repair of inordinately large defects.
If your wound requires daily care at home, you will be given detailed instructions following your surgery. For small post-surgical sites, direct closure by suturing the sides of the wound together may be possible. However, in certain areas of the body, there is very little tissue that can be stretched for coverage of a wound, and either a skin graft or skin flap must be used. In closing wounds with a skin flap, the skin adjacent to the surgical defect is partially cut free, and then rotated or moved forward to cover the surgical area. Stitches are then placed to hold the flap in its new position. This provides immediate coverage for the wound. Other areas may require a skin graft to provide coverage. Skin from the side of the neck, behind the ear, or over the collarbone may be cut free, placed over the wound, and then sewn into place. The original site of the graft is then closed with stitches or allowed to heal on its own.
Wound Healing, Scarring, and Scar Revision
As with all forms of surgery, a scar will remain after the skin cancer is removed and the surgical area has completely healed. Mohs micrographic surgery, however, will leave one of the smallest possible surgical defects and resultant scars. Often, wounds allowed to heal on their own result in scars that are barely noticeable. Even following extensive surgery, results are frequently quite acceptable. In addition, scars do have the ability, through the body’s own natural healing properties, to remodel and improve in appearance for a six to twelve month period. There are also many other techniques available to the patient for enhancement of the surgical area following skin cancer surgery. Depressed or indented scars may be elevated, using an implant such as Zyderm collagen. Likewise, a raised or roughened scar may be smoothed, using laser resurfacing or chemical peeling techniques. Skin flaps and grafts also may require a subsequent “touch up” procedure, to further improve their appearance.
Potential Complications Associated With Mohs Surgery
Patients should understand that there is not an absolute guarantee that any given procedure will be totally free of complications or adverse reactions. Mohs surgery is no exception. During surgery, tiny nerve endings are cut, which may produce a temporary or permanent numbness in and around the surgical area. If a large tumor is removed or extensive surgery is required, occasionally a nerve to muscles may be cut, resulting in temporary or permanent weakness in a portion of the face. This is, however, an unusual complication. The surgical area may remain tender for several weeks or months after surgery, especially if large amounts of tissue were removed. Rarely, some patients experience intermittent itching or shooting pain in the surgical area. In addition, the skin grafts and flaps used to cover surgical areas may not fully survive, requiring additional repair.
About the American Society for Mohs Surgery
The American Society for Mohs Surgery was established in 1990, and has experienced continued growth while honoring its commitment to the organization’s original tenets:
“The purpose of this organization shall be to promote the highest standards of patient care relating to Mohs surgery for the surgical removal of skin cancer and other appropriate malignancies; to establish quality assurance and regular peer review of Mohs surgeons; to provide a forum for the exchange of ideas and methodology for Mohs surgery and related basic sciences; to promote the professional education of its members and the medical community in the principles and practice of Mohs surgery; to encourage research into all methods of microscopically controlled removal of malignant tissue; and to provide information for public education relating to Mohs surgery.”