Mohs surgery is one of the most widely used and reliable surgical dermatology procedures to treat skin cancers. An experienced Mohs surgeon will explain the steps involved in the procedure to the patient at the time of initial consultation.
Suncoast Skin Solutions, led by board certified dermatologist Dr. Christopher Ewanowski, provides proven and effective skin care treatments to patients in Tampa, Brandon, Lutz, Seminole, Riverview, Brookesville, Winter Haven, Daytona Beach, Largo, St. Petersburg, Ocala, The Villages Central Florida, Florida, and surrounding communities.
Mohs Surgery for Skin Cancer – Procedure Steps
- The location of the skin cancer will determine whether a patient will be able to wear their regular clothes or will require a hospital gown. The Mohs surgeon will evaluate the area where the patient had their biopsy and may mark it with a pen for easy reference. The doctor will position the patient for best access implying that the patient may be sitting up or lying down.
A surgical drape will cover the area. In case the skin cancer is present on the facial skin, it may mean that the patient will not be able to view what is happening.
However, the doctor will communicate with the patient throughout the procedure. Subsequently, the surgeon will inject a local anesthetic to numb the area entirely, but the patient will remain awake during the procedure.
- The surgeon will use a scalpel to excise a thin layer of apparent cancerous tissue. Certain skin cancers may be like the “tip of an iceberg” implying that they may have extensions or roots that are invisible from the surface.
The following lab assessment will determine this aspect. A temporary bandage will be placed on the wound, and the patient can relax as the lab test commences.
- The surgeon dissects the tissue into sections and color codes these sections using dyes. They also draw a map of the surgical area. The lab technician freezes the dissected tissue and then makes very thin horizontal slices akin to a layer of cake.
They will then place these slices on microscopic slides and stain and cover them. This is an intricate and time-consuming process.
- The surgeon will assess all the edges and the tissue’s underside on the slides using a microscope. In case any cancer cells are visible, the surgeon will mark their location on the map and let the patient know that the removal of another skin layer will be necessary.
- The surgeon will administer more anesthetic to the patient, if required. They will them remove another skin layer exactly where the cancer cells remain according to the map. Subsequently, the lab work will resume on the newly removed tissue. This process is repeated as many times as necessary until the malignant cells are entirely removed.
- After the area is free of all cancerous cells, the surgeon may leave the wound open or seal it with sutures. This will depend on the location and size of the wound. In certain cases, the wound may require reconstruction via a skin graft which involves moving the surrounding tissue into the wound or performing a skin graft.
Sometimes the Mohs surgeon may coordinate the wound repair with another expert such as a plastic surgeon, hand surgeon, or oculoplastic surgeon. In general, the Mohs surgeon will repair the wound right after ensuring that the margins are clear.
- The patient should be prepared to spend many hours for this procedure, especially if more than one or two rounds of excision are required. It is worth the time investment as this targeted procedure has the highest cure rate of any technique and can save the most amount of normal tissue while creating the tiniest scar possible.
The patient should follow the doctor’s wound care, scar care, and follow-up guidelines carefully for best results.
SunCoast Skin Solutions Dermatology offices are located in Tampa / Hillsborough, St. Petersburg / Pinellas County, Brandon, Lutz (2 locations), Winter Haven, Largo, Riverview, Brooksville, Ocala, Largo at Bardmoor, Daytona Beach, Sarasota, and Palm Harbor, Florida. Contact us at 1-844-786-3376 or click here.
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