What is Mohs Micrographic Surgery?

Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer. The procedure was developed in the 1930s by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world.

What differentiates Mohs Surgery from regular excision?

Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all “roots” and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate – 98-99% for new skin cancers and 95% for recurrent skin cancers.

Who performs Mohs Surgery at Thomas Dermatology?

Both Dr. Thomas and Dr. Lieberman have specialized training in Mohs surgery, which they obtained both during and after completion of their dermatology residencies. Each of them is a member in good standing of the American Society of Mohs Surgery.

Who is a candidate for Mohs Surgery?

There are several indications for Mohs Surgery. It is typically reserved for skin cancers (most commonly basal and squamous cell carcinomas) that are located in cosmetically sensitive areas, such as the nose, ears, eyelids, lips, hairline, or in areas such as the hands, feet, and genitals, where maximal preservation of healthy tissue is critical for function. It is also the treatment of choice for recurrent skin cancers.

What should I expect during my visit?

Mohs surgery is performed as an outpatient procedure at both our Las Vegas and Henderson locations. The surgery is performed under local anesthesia and the patient will remain awake during the entire procedure. Dr. Thomas and Dr. Lieberman remove the visible cancer, along with a thin layer of additional tissue, which is termed a “stage.” Patients are asked to wait while the tissue is being processed and examined under the microscope. If residual cancer is found, the tumor is marked on a map that guides the excision of additional “stages” so that unaffected skin is spared. This process continues until no remaining tumor is identified.

While most Mohs cases can be completed in fewer than three stages, occasionally the tumor’s roots can be significant and require more than three stages. Therefore, it is difficult to estimate how long the procedure will take. On average, most Mohs cases can be completed in under four hours. However, it is advisable to reserve the entire day for the procedure, in the event that several layers are required to clear the tumor.

How will the surgical wound be reconstructed once the tumor has been removed?

Several options exist for closure of the wound. Dr. Thomas and Dr. Lieberman will discuss the various options during your visit, as the most appropriate option for reconstruction often cannot be predicted until the tumor has been completely removed.

These options include:

  • Simple side-to-side repair (“primary closure”)
  • Skin flap (movement of skin adjacent to the wound into the wound itself)
  • Skin graft (placement of skin from an unaffected area onto the wound where it is sutured in place)
  • Allowing the wound to heal on its own
  • Uncommonly, Dr. Thomas and Dr. Lieberman may enlist colleagues in plastic surgery to assist in the reconstruction of larger, complex defects.

How Should I Prepare For My Visit?

We ask that you continue to take all prescription medications, including blood thinners, prior to surgery. Please bring an updated list of medications to your visit. If you are taking Warfarin (generic for Coumadin), please notify us of your most recent PT/INR, drawn within 2 weeks of the procedure.

We ask that you discontinue any herbal supplements that may predispose to bleeding, unless ordered by your doctor, starting 7-10 days before surgery. These include garlic, gingko, ginseng, ginger, fish oil, coenzyme Q10, and vitamin E.

It is important that you obtain a good night’s rest and eat normally on your day of surgery. We recommend you wear casual, layered clothing and bring a light snack and reading material to occupy you during free moments. While many patients drive home after surgery, you may choose to arrange for someone to drive you home.

Should I expect much pain after the procedure? How do I care for the surgical site?

Most patients do not complain of significant discomfort. Often extra strength Tylenol is sufficient to control pain. However, in some cases, we may prescribe stronger pain medication.

At your visit, you will be provided with detailed instructions on post-operative care, including a discussion regarding signs and symptoms associated with possible complications, including swelling and infection.