What Is Mohs Surgery?
Mohs surgery is a specialized technique which can be used to remove non-melanoma skin cancers. Basal cell carcinoma and squamous cell carcinoma are the most common types of non-melanoma skin cancers, and Mohs surgery has an exceptional track record for treating these types of skin cancers. Dr. Jensen has completed an intensive 1-year fellowship in Mohs surgery, and has treated thousands of skin cancers, ranging from simple to complex.
What Are The Advantages Of Mohs Surgery?
While Mohs surgery is not necessary for all skin cancers, it has two distinct advantages over other tumor removal methods which make it appropriate in certain situations:
- Mohs surgery has the highest cure rate of all skin cancer treatment options. Cure rates for skin cancers treated with Mohs surgery can often approach 98-99%. When a skin cancer is removed using Mohs surgery, the Mohs surgeon checks all the edges of the tissue (~100%) that has been removed while the patient stays in the office. If skin cancer is present at the edge, then the Mohs surgeon can return to the patient and remove more tissue only where needed. Thus, the Mohs surgeon is able to remove the skin cancer with a high degree of certainty, resulting in a high cure rate. In contrast, a physician performing a traditional skin cancer excision will remove the tumor, place sutures, and send the tissue to a dermatopathologist. Over the next several days, the dermatopathologist will typically make sampling sections through the tissue, examining less than 1% of the total edge. Standard excisions still have a good cure rate, which is typically around 90%; however, the amount of skin that needs to be removed in an excision is typically larger than in Mohs surgery, often resulting in a larger scar.
- Mohs surgery generally results in the smallest scar of all surgical treatment options. As described above, Mohs surgery is a technique which allows the surgeon to check all the edges of the tissue that has been removed. As a result, Mohs surgeons are able to remove a smaller amount of normal skin surrounding the skin cancer while still preserving an excellent cure rate. This results in a smaller scar, less risk of damage to important anatomical structures, improved function, less pain, and faster healing.
There are three principle goals in the removal of skin cancers, each of which are important:
- Complete removal of the skin cancer
- Maintenance of function
- Aesthetic result
Although “aesthetic result” is third in this list, it is an extremely important aspect in the treatment of skin cancers and is often the top priority for patients. Mohs surgery is most often performed on the head and neck, which are highly visible areas and which contribute significantly to a patient’s identity and quality of life. Once a skin cancer has been removed completely, Dr. Jensen will focus on creating the best looking and least visible scar that will also maintain proper anatomical function. This is where art and medicine come together, and an understanding of proportion, form, and function are key in creating the best aesthetic result.
As mentioned above, while Mohs surgery is an excellent treatment option for skin cancers that have an increased risk of recurrence (or increased consequences if the skin cancer recurs), Mohs surgery is not necessary for all skin cancers. A variety of factors go into determining whether Mohs surgery is the best option. Prior to going forward with Mohs surgery, Dr. Jensen wants each patient to understand the procedure and feel comfortable with the treatment. He is happy to discuss the options and help you understand them, so you can make an informed decision for your health.
Frequently Asked Questions
Why is it called Mohs surgery?
Mohs surgery is named after Dr. Fredric Mohs, a general surgeon from the University of Wisconsin, who developed the technique. Originally, Mohs surgery was called Mohs chemosurgery due to the use of a fixative agent in the processing of the tissue. However, this technique has largely been abandoned in favor of the frozen section technique, what we use today. You may also hear Mohs surgery referred to as Mohs micrographic surgery, owing to the use of microscopic slides during the procedure.
My biopsy site has completely healed and I don’t see any more cancer. Do I still need treatment?
Generally, yes. A biopsy is intended to correctly identify and classify a skin cancer, not necessarily treat it. There are often microscopic roots that extend outward and downward from the visible skin cancer lesion. While the biopsy scar may have healed nicely and there does not appear to be any skin cancer left, these roots will often grow under the surface of the skin undetected. Treatment of the biopsy site with the appropriate procedure (Mohs, excision, etc) is recommended to ensure that the tumor has been completely removed.
Will Mohs surgery leave a scar?
Yes. Any time the skin is cut, as scar will result. Dr. Jensen has extensive training in reconstruction and will do his best to create an aesthetically pleasing result. If a scar does not heal as expected, a scar’s appearance can often be revised or rehabilitated to help it blend in with the surrounding skin.
Does Mohs surgery hurt?
Mohs surgery is performed using local anesthetic in the office. No general anesthesia is required. The local anesthetic is carefully placed at the site of the tumor with a small needle, which can cause temporary discomfort. Dr. Jensen and his highly-trained staff make every effort to numb the area in the most gentle way possible. Once you are numb, Mohs surgery is painless. You may feel gentle pulling or pressure, but the vast majority of our patients tolerate the procedure very well. Pain following the procedure is mild to moderate. Dr. Jensen will help tailor a plan for pain control based on your particular surgery. Please feel free to discuss any concerns you may have with Dr. Jensen. His goal is to make Mohs surgery a comfortable experience for each patient.
How long does Mohs surgery take?
Many years ago, Mohs surgery could take days or weeks. However, with the use of frozen sections, modern Mohs surgery typically takes 2-4 hours. Each time tissue is removed, it must be processed in the lab (which is located in the office) and microscopic slides must be made and examined. This length of this process can vary and is dependent upon many things, including the size and location of the skin cancer.
What is the average number of times (stages) needed to remove a skin cancer with Mohs surgery?
Typically, a skin cancer is able to be removed within one or two stages. Occasionally, three or more stages are needed, but this is the exception rather than the rule. Dr. Jensen’s practice is in line with national averages.
What should I bring to my Mohs surgery appointment?
- Wear comfortable, loose-fitting clothing. If your skin cancer is on the leg, consider bringing or wearing shorts.
- If you would like to bring work or other items for work, please feel free to do so. You may connect to our WiFi and access the Internet, if needed.
- Book, magazine, or other reading material. You may also feel free to bring an electronic device and connect it to our WiFi.
- Snacks and drink. Our office also has snacks and drinks, if needed.
- If Dr. Jensen has prescribed any medications for you to take at the time of your procedure, please bring these with you to your appointment. If you are being prescribed an anxiety-reducing medication, please do not take this medication until you have sign the informed consent form.
- If recommended by Dr. Jensen, please plan for someone to transport you to your home following the procedure. As most Mohs surgeries are on the face, the bandages can ofter obstruct vision, making it unsafe to drive home. If you have any questions about whether or not you will need a driver, please feel free to ask and we will be able to make a recommendation. Please note that if you have requested to take any kind of anxiety-reducing medication for your surgery, that you will be required to have a driver.
Should I take my medications prior to, or immediately following, my Mohs surgery appointment?
Unless indicated otherwise, please continue to take your medications as directed by your other physicians. In exceptional cases, we may discuss stopping blood-thinning medications with your prescribing doctor. However, most Mohs surgeries can be safely performed with blood thinning medications on board. At least 2 weeks prior to your procedure, please be sure to tell our office if you are taking any blood thinners.
Do I need antibiotics before or after my procedure?
Mohs surgery has a very low rate of infection, and routine antibiotics are generally not necessary. However, some patients are at increased risk for infection or have increased consequences if an infection occurs. These patients have typically had an orthopedic surgery (i.e., joint replacement), are immunocompromised, or have problems with their heart valves, among other select scenarios. If you have been told by your physician that you need antibiotics for surgical or dental procedures, please let us know prior to your Mohs surgery appointment.
Additionally, there are certain areas on the body which are at higher risk for infection, and if your surgical site is on one of these areas, Dr. Jensen will discuss the option of adding a short course of post-operative antibiotics to help prevent infection.
May I eat prior to my procedure?
Generally, yes. Mohs surgery is performed under local anesthesia and you are encouraged to eat a regular meal prior to your procedure. While we have snacks in the office, we recommend that you bring a snack with you to your appointment. This is especially true for patients who are diabetic.
If your reconstruction will be performed in the operating room due to it’s location or size, we recommend that you follow the instructions given by the surgeon performing the reconstruction.
What is the advantage of having a fellowship-trained Mohs surgeon perform my surgery?
A Mohs surgeon who has completed an American College of Mohs Surgery fellowship has undergone extensive training in the Mohs surgery, including participation in at least 500 Mohs surgery cases over a 1-2 year period under the supervision of a highly-qualified Mohs surgeon. Dr. Jensen participated in or performed approximately 1,500 cases during his fellowship training and has performed many more cases since finishing his training.
What should I expect after the procedure?
Patients are often surprised by how smooth recovery from Mohs surgery can be. You may have mild to moderate discomfort that can be treated with simple, over the counter pain relievers. The pain will generally start to improve after 2-3 days. You may have a small amount of oozing or pink color around the wound as it heals.
What should I do to care for the surgical site?
Each surgical site is different and will require varying degrees of attention. We will give you instructions specific to your surgical site at your appointment. Typically, we will ask you to keep your dressing on for 2 or more days without getting it wet. After 2-3 days, the dressing may be gently removed and the surgical site can get wet in the shower. It cannot be submerged under water (i.e., no baths or swimming) until after stitches are removed and you are given clearance from Dr. Jensen. After you have allowed water to gently run over the surgical site, gently pat dry, apply a thin layer of petroleum jelly (Vaseline, Aquaphor, etc), and cover with a bandage. Repeat this once daily until sutures are removed.
If you have had a flap or graft, your instructions may vary from the above. We will give you specific instructions, as needed.
Where do I obtain supplies for the care of my surgical site?
Many pharmacies and health supply stores have a wide array of bandage supplies and you are welcome to purchase those items, if desired. For convenience, Clarity Dermatology also sells kits which include special tape, sterile petrolatum ointment, and non-adhesive gauze to patients at cost.
Who should I call if there is a problem following my procedure?
Please call the office at 720.686.SKIN at any time if you have a question or concern about your wound. If you call after business hours, you will be redirected to our paging service, who will get in touch with Dr. Jensen in an emergency.
Where can I learn more about Mohs surgery?
The American College of Mohs Surgery has excellent information for patients.