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A Quick Guide to Mohs Surgery for Skin Cancer

A healthy eyelid after a Mohs surgery

The most diagnosed type of cancer in the United States of America is skin cancer, with one out of five people being afflicted with the disease by the time they reach the age of 70. A malignant growth is typically found on areas of the skin that are frequently exposed to the harmful rays of the sun but can also manifest itself on the more covered portions of your body due to genetic dispositions, consequences of lifestyle choices, and excessive exposure to toxins.

There are three kinds of ultraviolet (UV) rays. UVA and UVB rays reach the Earth while the third and dangerous kind, UVC rays, is completely blocked off by our ozone layer. UVA rays go deep inside our skin, inflicting cellular damage, photo-aging, and immune suppression. On the other hand, UVB rays reach only the epidermis, the outermost covering of our skin, and is responsible for sunburns. Both UVA and UVB rays contribute to the chances of developing dividing tumors rapidly.

The Mohs surgery for skin cancer is a sophisticated medical procedure that was developed to revolutionize the approach to treating malignant growth on the skin. It is considered the gold standard for treating skin cancer as it is micrographically monitored to excise all cancer cells while preserving as much healthy skin as possible.

What is Mohs Micrographic Surgery?

Unlike other forms of skin cancer treatments, Mohs micrographic surgery is capable of determining where the cancer stops in real-time. This is made possible via micrographic monitoring throughout the entire procedure, which involves examining each layer of the excised skin under a microscope to make sure that no cancer cells remain unremoved after the surgery.

Since the surgeon can see exactly how far the cancer has penetrated the skin, the Mohs surgery keeps your healthy tissues intact and significantly cuts the chances of the cancer from recurring. Moreover, post-operative scars heal smoothly under proper care, giving a tremendous cosmetic advantage especially when performed on prominent and delicate parts of the body.

Who are Candidates to Undergo Mohs Micrographic Surgery?

Patients who suffer from basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the two most prevalent types of skin cancer, are perfect candidates to undergo a Mohs micrographic surgery. This is especially true when the BCC or SCC is large, aggressive, has reappeared, with uneven edges, or is situated along fragile parts of the body such as on the face, extremities, or private areas.

The Mohs surgery can treat the most severe kind of skin cancer known as melanoma, specifically lentigo maligna melanoma, in its early stages. This form of skin cancer is brought about by damages from constant sun exposure and is isolated near the surface of the skin for a specific period, thus opening itself up for easy removal. Rarer cases like dermatofibrosarcoma protuberans (DFSP), extramammary Paget’s disease, and Merkel cell carcinoma are also treatable using the Mohs micrographic surgery.

Healthy lips after full recovery from Mohs micrographic surgery

What are the Benefits of Mohs Surgery?

Opting to undergo a Mohs surgery for skin cancer presents multiple advantages over choosing alternative routes. The procedure removes segments of the skin that are afflicted with cancer in an extremely accurate manner to prevent cutting off and damaging healthy tissues. This precise method allows for more of the unaffected areas to remain healthy and untouched. Patients also end up with smaller scars as opposed to those produced by traditional excisions since only small portions of the infected skin are taken out at a time.

Depending on the size of the area removed, some wounds from the operation may heal entirely even without stitches. As such, the Mohs technique provides excellent restorative after-effects both in terms of appearance and functionality, making it the perfect course of action for skin cancer located on the eyelids, nose, lips, hairline, hands, feet, and genitals.

The Mohs surgery is a reliable means of eradicating the target disease, having a cure rate of over 99 percent for new skin cancers and 95 percent for recurrent ones. Its high cure rate is attributed to the fact that it is capable of examining 100 percent of the margins of the tumor and thus minimizing the chances to miss out and leave behind small tumor clusters. Mohs micrographic surgery is also considered to be more cost-efficient due to its high cure rate as you will most likely only need to undergo surgery once.

What Can You Expect When You Opt for a Mohs Surgery?

Just like any other medical procedure, the Mohs surgery for cancer must be met with preparatory consultations, preliminary medical examinations, and careful planning to ensure the best results.

How to Prepare for the Surgery

Before proceeding with the surgery, make sure to inform your doctor of any underlying medical conditions to prevent complications. It is standard to be asked about your complete medical history to make sure that you won’t have adverse reactions to any of the steps in the procedure or the drugs that you will be taking. You will also be given an opportunity to ask questions during your preoperative consultations after your Mohs surgeon explains what you need to know about the procedure.

It is in your best interest to prepare yourself for the surgery in ways which include the following:

  • Get enough sleep, especially the night before the operation.
  • Eat healthy food.
  • Dress comfortably.
  • Disclose all of the existing medications you are currently taking to your doctor (you may need to stop taking some of them before the surgery).

Mohs Procedure for Skin Cancer

The Mohs procedure for skin cancer is carried out under local anesthesia over the affected area. Your surgeon will begin by removing a slightly larger layer of your skin containing the visible tumor. Afterward, a temporary bandage will be placed over the excision as you await the first round of laboratory results.

In the lab, the extracted skin will be analyzed under a microscope to check if it has residual cancer cells. This examination will determine how deep the tumor has penetrated the skin and will be the basis of the Mohs surgeon’s plan of action on how to remove the cancer all the way to its roots. Although it is possible to eliminate all of the cancerous tissues on the first cut, a second excision may be required if analysis shows lingering abnormal growth.

This process is repeated until no more sign of the cancer cells is found under microscopic examinations. Finally, the surgeon will take into account the size and location of the surgical site and decide whether or not to use stitches or adhesives to close the wound. The whole operation can take several hours depending on how many rounds of integumentary extractions are needed.

Mohs Surgery Recovery

Recovering from a Mohs surgery starts with a pressurized dressing to support blood clotting and lower the risk of excess blood loss. The pressurized dressing will stay on for about 24 hours after the procedure. Minimal discomfort is to be expected as well as some bruising and swelling. The uneasiness is usually manageable and should subside within a week after the surgery. You can also ask your doctor for prescription medicine if you find that the pain is impairing your daily functions. Additionally, applying a cold compress over the swollen area may also relieve some of the pain.

On the contrary, scars from the surgery take several months to fade completely. To ensure that you are progressing through your healing process in a timely and problem-free manner, your doctor will schedule a few consultations post-surgery. The consultations will give your surgeon the opportunity to monitor your condition closely and confirm that no complications have surfaced that will impede seamless recovery.

Caring for Your Skin After Mohs Surgery

While the Mohs micrographic surgery is conducted only under localized anesthesia, it is advised that you make arrangements to have someone take you home after the operation. The procedure may cause dizziness, making it ill-advised to drive yourself home after the operation. You should also bear in mind that it is imperative to schedule the surgery in such a way that you would not be required to do strenuous activities for the first 48 hours after the procedure. Heavy lifting, exercise, and the like may cause the wound to reopen and bleed.

Also, ask your doctor for specific aftercare instructions to guarantee that you prevent infections. This involves keeping the surgical site completely dry for about a day to prevent infection. You will also have to carefully clean the wound and moisturize it with the appropriate products to minimize scarring. After complete recovery, constant care is still needed by your skin, which calls for adhering to a proper skin care regimen, a healthy lifestyle, and staying away from extreme sun exposure.

When to Visit Your Surgeon

Watch out for signs of infection in the wound and unordinary levels of discomfort as these may demand the attention of your attending physician. Some of these may include but are not limited to the following:

  • Green or yellow discharge from the wound.
  • Thread-like patterns or splotches of redness extending beyond the surgical site.
  • Fever.
  • Unbearable and relentless pain.
  • Enlarged lymph nodes.
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