Preparing for Mohs Surgery

Surgeon performing Mohs surgery on a hand

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Surgery is the most commonly used treatment for skin cancer because it offers the highest cure rate of any skin cancer treatment. If you have been diagnosed with skin cancer, your doctor will discuss your treatment options, which may include surgery or non-surgical treatments such as cryotherapy or photodynamic therapy. In most instances, however, surgery will be the recommended treatment.

Depending on the severity and extent of your skin cancer, your doctor will recommend either traditional surgical excision or Mohs surgery. During surgical excision, a local anesthetic will be injected and the doctor will remove the tumor and a portion of surrounding healthy tissue (called “the margin”) using a scalpel. The tumor and tissue are then sent to a lab for testing to ensure all cancerous cells have been removed. Mohs surgery is a specialized form of surgical excision. During this procedure, the surgeon removes the visible tumor and then begins to remove surrounding tissue layer by layer. After each layer, he or she examines it under a microscope to determine if any cancerous cells are left. The surgeon repeats the process until he or she is sure that all cancer cells have been removed.

Pre- and Post-Operative Instructions

Once your surgery has been scheduled, you will be given a set of pre-operative and post-operative instructions. It is essential that you follow these instructions to ensure your safety and an optimal result. The instructions for traditional excision and Mohs surgery are very similar.

Before surgery, you may be asked to stop any medications or activities that increase your risk of bleeding. This may include taking aspirin, ibuprofen, and certain herbal medications, smoking, and drinking alcohol. You may eat before your surgery and most doctors will encourage you to bring a snack along, as Mohs surgery can take several hours.

Your doctor will give you specific instructions on how to care for your skin and the surgical site after the skin cancer is removed. Following these instructions lowers your risk of infection and helps the wound heal more quickly.

Some of the instructions your doctor may give you include:

  1. Avoid strenuous activities for 24-48 hours following surgery and refrain from exercising for at least 2-3 weeks to allow your surgical site to heal properly
  2. Keep the would dry and covered for 24 hours
  3. Wash with wound with soap and water twice daily and apply an antibacterial ointment (such as bacitracin) or Vaseline, depending on your dermatologist’s instructions
  4. Avoid alcohol and smoking cigarettes as these are known to slow the healing progress.
  5. Once the wound has healed, avoid exposing it to the sun as this may worsen your scar and make it more visible.

In addition, your doctor will talk to you about how to better care for your skin to avoid developing skin cancer in the future. You should plan to minimize sun exposure as much as possible during peak hours of the day (10 am-2 pm) and wear sunscreen and a hat when you do go outside. You will also be shown how to perform a skin self-check so you can identify suspicious growths as early as possible.

Benefits and Disadvantages

The clearest benefit of surgical excision is its high cure rate. Surgical removal of skin cancer has a cure rate above 95%, while the cure rate of Mohs surgery is around 98%. Surgical excision is also a relatively quick, low-risk procedure. In comparison to surgical excision, Mohs surgery takes a longer time to perform and is a considerably more expensive procedure. For this reason, Mohs surgery is only performed in situations where it is deemed necessary.

The major disadvantage of surgical excision and Mohs surgery is that both of these procedures will result in scarring. In some instances, the scar may be barely visible after the wound has healed, but in others, the scar may be very visible and even disfiguring. When a large growth or a smaller growth on a highly visible area is being removed, reconstructive surgery and/or skin grafts may be required after the skin cancer has been removed.

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