Skin cancer is the most common type of cancer in the world. In the United States alone, one in five Americans will develop skin cancer at some point during their lifetime. Skin cancer occurs when there is a growth of abnormal skin cells that cannot repair themselves, resulting in mutation and the formation of a cancerous tumor. This is often related to harmful UV (ultraviolet) rays from the sun, which are known to contribute heavily to the formation of cancerous tumors in the skin.

Though the mention of skin cancer is very scary to most people, the good news is that skin cancer is often very easy to treat, if caught early. Basal cell carcinoma, the most common form of skin cancer, is almost never fatal, but it can be disfiguring if allowed to grow. Squamous cell carcinoma is intermediate in its aggressiveness. It can grow destructively, and in some cases may spread to neighboring lymph nodes. Melanoma is the most deadly form of skin cancer, but even these tumors can be successfully treated in many cases.

The first step in treating early skin cancer is removal of the cancerous cells, which involves minor surgery. One of the most common methods for surgical removal is the MOHS technique, which is intended to preserve as much healthy tissue surrounding the cancerous growth as possible. As a board certified facial plastic surgeon, Ross A. Clevens, MD, FACS knows how important it is to preserve patients’ aesthetic appearance while ensuring full removal of cancerous cells, which is why he offers MOHS surgery to his patients in Melbourne, FL.

What is MOHS Surgery?

MOHS surgery was developed by Dr. Frederic Mohs, a professor at the University of Wisconsin in the 1930’s, and the technique was named after him to honor his achievement.

MOHS involves a unique approach to surgical excision of cancer cells. Each layer of skin is removed in the area of the tumor and is examined carefully under a microscope. During this process, Dr. Clevens will work as a team with his pathologist to identify and map each layer to get a precise picture of the cancer cells present. Once the skin has been cleared of cancer cells, the area will be reconstructed to minimize scarring and surgical defects, a step that is particularly important for facial tumors.

Benefits of MOHS Surgery

MOHS has many benefits over other surgical skin cancer treatments. By examining each layer of skin during the process, MOHS takes a lot of guesswork out of the equation for both surgeons and patients. There is no need to take more tissue out than is necessary, and patients can get through their ordeal more quickly without waiting for lab results. By minimizing tissue damage, surgeons can give patients better cosmetic results while reducing chances for tumor reoccurrence in the same area.

Who is a Good Candidate?

If you have been diagnosed with skin cancer, then you may be a good candidate for MOHS surgery. Most MOHS patients have skin cancer growths on the face, but the treatment can be appropriate for other areas of the body as well. Only you and your surgeon can determine which treatment option is right for you, however. This will be discussed during your consultation.

Your MOHS Consultation

Before you undergo treatment for your skin cancer lesions, you will need to have a one-on-one consultation with Dr. Clevens to discuss your diagnosis and formulate a treatment plan. During your consultation, Dr. Clevens will go over your medical history and determine whether or not you are a good candidate for MOHS surgery. If not, he will discuss other options for you. During this meeting, you’ll also be able to get to know Dr. Clevens, learn more about the procedure, and ask any questions you may have.

The MOHS Procedure

Once you have been cleared for surgery, you’ll be scheduled for your MOHS procedure. Typically, the surgery does not require general anesthesia or IV sedation, but many patients appreciate oral sedation along with local anesthesia during the procedure.

Dr. Clevens will start by removing the first layer of skin in the area of the lesion, being careful to remove enough from around the lesion to remove the cancer cells. This layer will then be examined by a board certified pathologist under the microscope and mapped. The procedure will then continue and repeat until all damaged tissue has been removed. Then, local flaps, skin grafts, and other reconstructive techniques may be used before the incisions are closed and the surgery is complete.

Recovering from MOHS Surgery

As an outpatient procedure, the recovery period should not be especially long or difficult, but this does depend on the size of the lesion and the extent of the reconstruction. Pain medication will be prescribed to control any discomfort, and you will be given specific instructions on how to care for your wound, as well as any activity limitations you should observe during the recovery period. It can take a while for scarring to become less apparent and for swelling to subside, so it’s important to be patient during your recovery.

FAQ

Will cancerous tumors ever come back after MOHS surgery?

While it’s always possible skin cancer will reoccur following surgical treatment, it is very unlikely with MOHS surgery. MOHS surgery aims to ensure that all skin cancer cells are removed and typically carries a 97-99% cure rate although this may vary from individual to individual and depends in part upon the type of skin cancer.  The cure rate with MOHS surgery compares favorably with radiation therapy and conventional surgical excision, each of which offers a 70-80% cure rate.

Why does such a large amount of tissue need to be removed?

While it may seem like a lot of tissue is removed during a MOHS procedure, the truth is that the method actually minimizes the damage to the area by not removing more than is necessary. A small visible growth may be influenced by a large number of cancerous cells underneath the skin, which necessitates the removal of more tissue. Your surgeon will remove enough tissue to ensure all of the cancerous cells are removed but will try to minimize the damage to the area.

Who should perform my MOHS surgery?

It is best to choose a surgeon who has experience in both the MOHS technique and aesthetic surgery to help improve the cosmetic outcome after the procedure. This is especially important when the cancerous cells have caused tumors in the facial skin.

Will there be any scarring from the MOHS procedure?

All surgery produces some scarring, but the MOHS technique is used to minimize damage and often results in a very good cosmetic outcome.

Will I need more than one procedure?

One of the biggest benefits of MOHS treatment is that analysis is performed during the procedure so the surgeon can ensure all the cancer cells are removed. Because of this, both the surgery and the reconstruction can be done at once in most cases, eliminating the need for a waiting period or additional procedures. In more complicated cases or where critical facial regions are involved, it is often better to stage the MOHS surgery and reconstruction into two separate procedures.

What are the risks of MOHS?

As with any surgery, there are some risks involved with MOHS, but they are very minor. Bleeding, infection, and scarring can occur, but this is very rare. MOHS is a very safe surgery and is typically necessary for ensuring skin cancer does not cause disfigurement.

Are there other options for surgery?

Yes, there are other surgeries that are often used to treat skin cancer. MOHS surgery offers superior cure rates and better cosmetic results than either radiation therapy or conventional surgical excision.

Are there some forms of cancer that cannot be treated with MOHS?

Some aggressive forms of skin cancer require other treatment plans, which may not involve MOHS surgery.

How long does the MOHS procedure take?

The length of the surgery will depend heavily on the tumor. However, most MOHS surgeries take about less than an hour, on average.

What preparations should I make for my surgery?

As with any surgery, there are some risk factors you should account for when preparing for your procedure. You should stop smoking before and after your treatment, as this can cause a host of complications, including poor healing. Your surgeon may also instruct you to stop using certain supplements before your procedure.

A True MOHS Expert

If you need skin cancer treatment, it’s important to do your research and choose an experienced surgeon who has performed many MOHS procedures in the past. If you’re ready to discuss your treatment options with a true MOHS expert, give Facial Plastic Surgeon Ross A. Clevens, MD, FACS a call at 321.727.3223 to set up a consultation. Trained at Yale, Harvard, and the University of Michigan, Dr. Clevens performs more than 250 MOHS procedures each year in Melbourne, FL, and is standing by to help you plan your treatment.