What is Mohs Surgery?

If you have recently been diagnosed with skin cancer, you are not alone.

Over one million people are diagnosed with skin cancer in the U.S. each year, making it the most common type of cancer. One in five Americans will develop skin cancer in his or her lifetime. Fortunately, it is also one of the most treatable forms of cancer.

Patients often ask, “What should I be looking for if I suspect a skin cancer?” The following signs should be promptly investigated: a new skin growth that does not disappear in four to six weeks; any skin lesion that continues to grow and turns red, brown, black or is multicolored; a mole, birthmark or beauty mark that increases in size, changes color or texture or becomes irregular in outline; an open sore or wound that refuses to heal, persists for more than four weeks or heals and later reopens; any skin spot or growth that continues to itch, hurt, crust over, form a scab, becomes a sore or bleeds for several weeks.

Moh’s Micrographic surgery performed by a fellowship-trained surgeon is an advanced treatment for complex cancers that has been developed and refined over the last 70 years. It offers the highest cure rate, even if the cancer has been previously treated by another method. The benefit of the Moh’s surgeon being trained in pathology is that it allows the surgeon to immediately examine the tumor to make sure all diseased tissue is removed. Other surgical techniques require the tumor to be removed, the wound closed, and the tumor sent to a pathologist to determine if all the cancer was completely removed. The Moh’s procedure removes that wait and the uncertainty that more surgery may have to be done if all of the cancer is not removed.

Fellowship-trained Moh’s surgeons have extensive experience in the reconstruction of the wound caused by removing the tumor. Their advanced training means patients will not need to see another reconstructive or plastic surgeon in most cases.

At Georgia Skin Cancer & Aesthetic Dermatology you can be assured of excellence. Dr. Campbell will provide care with compassion and strive to provide the most aesthetically pleasing outcome achievable.

Dr. Frederick Mohs developed the Mohs procedure in the 1930s. Mohs Micrographic Surgery is an outpatient procedure that involves the surgeon removing the visible tumor and then creating a map or diagram of the cancer site. The surgeon then removes smaller and smaller sections of surrounding tissue, which the surgeon immediately studies under a powerful microscope, until the surgeon determines that all the cancer has been removed from the diagrammed area. Once the cancer has been removed, the surgeon repairs the wound using the most advanced reconstructive procedures.

Benefits of Mohs Surgery

The Mohs technique provides the following benefits:

  • Success – Mohs Surgery provides the highest cure rate of any treatments for skin cancer—up to 99% and substantially decreases the chance of skin cancer recurrence.
  • Preservation – Mohs Surgery minimizes the removal of normal skin tissue allowing for potentially smaller scars.
  • Safety – Mohs Surgery is performed under local anesthesia. This permits faster patient recovery and a lower risk of complications, especially for older patients.
  • Integration – The Mohs surgeon is specially trained to complete your skin cancer treatment, interpret the pathology evaluation, and complete most wound reconstruction in the same visit. When needed, your care may be coordinated with other specialists to optimize your outcome.

The Procedure

Unless instructed otherwise, eat your regular breakfast and take all of your regular medications on the day of surgery. You will check in with a nurse who will confirm that you have followed any pre-operative instructions specified during consultation.

When you are ready, the doctors will clean the surgical field with an antiseptic and the area surrounding the skin cancer will be anesthetized (numbed) by a small local injection, usually similar to the one you received for your biopsy. You will not be placed under anesthesia. There is a needle stick only. Once the surgical area is numb, the skin cancer will be removed and sent to the lab for microscopic examination.

The process of creating and reviewing the cancer may take 30-45 minutes. We recommend you have a book, cellphone, or friend to keep you company during this time. Based on the results of the microscopic exams, if there is any cancer left, the surgical field will again be cleaned, numbed, and additional tissue may be removed. This process of removing tissue is repeated until the entire tumor has been eradicated as determined by microscopic examination.

The number of rounds required to entirely remove the tumor varies from patient to patient. Most of the time, skin cancers are fully removed in two or three rounds. Similarly, the exact size of your wound will not be known until all microscopic exams are finished. As soon as these tests are complete, your wound is repaired. Different techniques for repairing a surgical wound are available and will be discussed with you in full detail at the time of surgery.

mohs ilustration

Preoperative Instructions & Checklist

  • No alcohol five days prior to surgery
  • Eat a light breakfast before surgery
  • Eat a light lunch before surgery
  • Please limit your party to two friends or family members. Our waiting room cannot accommodate excess visitors. Family members will wait for you during the surgery in our waiting room.
  • Plan to be at our office for 4-6 hours. You will not be in surgery for this entire duration, but consultation and analysis times may vary.
  • Cancel all activities for the day of surgery and possibly longer. You will receive postoperative instructions before you leave our office.
  • Prepare to spend the night before your surgery if you are coming from out of town as well as the night of surgery in case the surgery becomes more extensive.
  • You may bring a sweater to be worn in the waiting rooms because the temperature in our office is very cool, although it will not be allowed in the operating room.
  • Do not apply makeup on the day of your surgery.
  • You will be required to remove your shirt, so you may prefer not to wear one-piece garments (e.g. jumpsuit). A gown furnished by the office will be worn to surgery.
  • Report any changes in your health including fever to your doctor’s office.
  • Check your medications and bring a list of all medications you are taking. If you are unsure of your medication, please call our nursing staff at 706-543-5858.

Download this preoperative checklist