Mohs micrographic surgery is a highly effective, highly detailed surgery that is common in treating basal cell carcinoma and squamous cell carcinoma. Mohs micrographic surgery is a tissue sparing surgical procedure that involves a doctor excising the cancerous lesions from the top layer of the skin and working downward. After the skin layers are removed, they are immediately examined through a process called histology. This consists of microscopically examining tissue that have been frozen and treated with a special dye to determine if any more cancer remains.

Since this is a detailed surgery, which requires special skill and expertise, it is important to go to a highly trained and experienced dermatologist. Dr. Matthew Barrows is skilled in performing Mohs micrographic surgery successfully and effectively. In addition, Dermatology & Skin Cancer Surgery Center has a plastic surgeon on staff who can work with patients post-surgery to repair all defects following surgery.

Procedure process

A doctor will use a local anesthetic to numb the surgery site. Before beginning to excise, or cut, horizontal layers of the cancer starting from the top-most layer. The layer will immediately be frozen, treated with dye and looked at under a microscope. This allows for an immediate microscopic examination of the excised cells, which is known as tissue histology. A tumor map is generated to see if any more cancerous cells remain. If more cancer cells are discovered, another layer of skin will be removed. This process will continue until there is no more cancer present. Once complete, the doctor will examine the wound and will either use sutures to stitch it up or, in some cases, call in our plastic surgeon for further consultation.

What to expect

Compared to other skin cancer treatments, Mohs is significantly more labor intensive and can require more than one physician to successfully perform the surgery. A patient might encounter up to 4 doctors during the surgery, including a surgeon, histotechnician, pathologist and a reconstructive or plastic surgeon. Since an anesthetic is used, most patients experience little pain during surgery but may feel mild discomfort. As an outpatient surgery, Mohs is performed in our office. The entire process can take several hours depending on the complexity or size of the cancer.

Treatment aftercare

After surgery, most patients experience little pain so medication usually is not required. If there is pain associated with the surgery, a doctor will normally advise an over-the-counter painkiller. While the majority of patients are able to return to normal activities by the next day, patients must refrain from taking part in strenuous exercise for 1-3 weeks. If the wound was stitched, the stitches will be removed anywhere from 4 to 14 days after surgery. Since the cancer is removed layer-by-layer, micrographic surgery provides a high cure rate as well as preserves surrounding healthy skin, but there is always a potential for scarring. It is unlikely that cancer will recur after this surgery. When treating basal cell carcinoma, the success rate is 97%-99%. Squamous cell carcinoma has a cure rate of around 94%. Treating melanoma-in-situ is heavily dependent upon the skill of the surgeon and the success rate can range anywhere from 75% to 95%.