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Mohs Micrographic Surgery

Ralph A. Massey, MD Santa Monica & Encino, CA

Mohs Micrographic Surgery

What is Mohs Micrographic Surgery?

Mohs surgery is a highly specialized form of skin cancer surgery. Most skin cancers extend under the skin beyond what is seen on the surface. Therefore, Mohs surgery has two stages: first all the visible tumor is removed, then while the patient waits, the tissue is processed and carefully examined under the microscope. If there is any cancer remaining, another thin margin of skin is removed, from the affected area only, and this is again examined. The whole process is repeated until all the cancer has been removed.

What are the Advantages of Mohs Surgery?

Mohs surgery has two main advantages over other skin cancer treatments. First, for most skin cancers Mohs surgery offers the highest cure rate possible, approximately 99%. Second, as Mohs surgery is guided by what is found under the microscope, it removes the least possible amount of skin while still removing all the cancer. This is especially important for lesions on areas such as the ear or face.

In the Mohs Micrographic Surgery, the skin cancer is surgically removed layer by layer, and the tissues are examined under a microscope until cancer-free and healthy tissue present around the tissue called clear margins is reached. Because of the way the tissue is removed and microscopically examined, this unique and effective procedure evaluates 100% of the surgical margins.

Dr. Massey will do a pathologic interpretation of tissue margins on the site. He will be able to correlate the microscopic findings with the patient’s surgical site. Here are some of the benefits offered by the Mohs surgery:

  • Since there is no general anesthesia used during the procedure, the recovery after the surgery is quicker, safer, and easier.
  • The surgery ensures that the cancer is completely removed and virtually eliminates any chance of cancer coming back.
  • It minimizes the amount of lost healthy tissue and maximizes the cosmetic and functional outcome from the surgery.
  • The site of the surgery will be repaired on the same day of cancer removal in most cases.
  • This procedure is used for curing skin cancer when every other method has failed.

In other skin cancer treatments, the amount of tissue that must be treated is estimated blindly. This means that there is a chance of missing cancer tissues that results in tumor regrowth and unnecessary healthy skin tissue removal. The high success rate of Mohs surgery ensures that most patients need only one surgery. Patients undergoing the procedure can feel safe in the skilled hands of Dr. Massey. He will provide a comfortable environment and work diligently to provide you with the excellent care you deserve.

Who Performs Mohs Surgery?

Training in Mohs surgery requires a one or two year fellowship after completing a dermatology residency. Dr. Massey completed his fellowship in Mohs Micrographic and Cosmetic Surgery at Columbia University in New York.

Is Mohs Surgery Painful?

No. Mohs surgery is performed with local anesthetic. This means that the area will be made totally numb, so the patient is awake but does not feel any pain.

How Long does Mohs Surgery Take?

It is impossible to know before the surgery exactly how extensive the cancer is below the surface. If the cancer is limited to what is seen clinically, then only one or two stages of Mohs surgery may be needed to eradicate the tumor. However, occasionally the cancer extends far beyond what might have been expected and so several stages are required to achieve a cure. As a result, patients may be in the office for just a couple of hours or literally the whole day. Most of this time is spent in the waiting room, talking, eating and reading, while the tissue is being processed and examined under the microscope.

How will the Wound be Repaired?

Once all the cancer has been removed the wound will be assessed and the best reconstructive options discussed with the patient. Sometimes the wound will be left to heal without reconstruction or sutures, in other cases the best cosmetic result can be achieved with a relatively simple repair, while for others complex reconstruction utilizing flaps or grafts may be the best option. Once the most appropriate reconstructive option has been agreed upon, the patient will be scheduled for that surgery, typically the very next day. (Learn more about reconstructive surgery by clicking here.)

Is Mohs Surgery Right for Me?

Mohs surgery is not indicated for every skin cancer. It is most commonly used for;

  • Skin cancers on important or high-risk locations such as the face or hands.
  • Tumors that have reoccurred after a previous treatment.
  • Large or rapidly growing tumors.
  • Patients who have a predisposition to multiple skin cancers.

Your doctor and / or Dr. Massey can discuss with you whether Mohs surgery is right for you.

Patient Instructions Prior to Mohs Surgery

  1. DO NOT take aspirin, or products containing aspirin or Motrin, Advil, Ibuprofen, or any similar medications for seven (7) days before and two (2) days after surgery. These medications may cause increased bleeding both during and after surgery. Note: If your medical doctor has requested that you take aspirin, please ask your medical doctor if you may safely discontinue the aspirin before your surgery.
  2. If you take any prescription blood thinners (eg. plavix or coumadin) please ask your prescribing physician if you can safely discontinue these 3 days prior to your surgery.
  3. You may take Tylenol for any aches or pains both before and after your surgery. (Tylenol does not increase the risk of bleeding).
  4. It is very important that you DO NOT SMOKE for one (1) week before and for at least two (2) weeks after your surgery. Smoking will severely affect normal healing.
  5. Prior to surgery, please purchase the following items in order to care for your surgical wound properly.
    1. 3% Hydrogen Peroxide (this can be purchased from you pharmacy).
    2. Cotton tipped swabs (such as Q-tips).
    3. A new tube of Vaseline, Aquaphor- or any over-the-counter antibacterial ointment.
    4. Telfa pads (or any non-stick dressing).
    5. Paper tape.
    6. Gauze pads – 4 X 4.
    7. An over the counter chlorhexidine soap (eg. Hibiclens)
  6. Please use an over the counter chlorhexidine soap (eg. Hibiclens) in the shower instead of regular soap for several days before and after your surgery.
  7. ON THE DAY OF SURGERY PLEASE…
    • Do not wear any make-up to the office.
    • Wear a button-down top rather than a pull-over top.
    • Take all your usual medications (except blood thinners as discussed above).
    • Eat your normal breakfast, and bring a packed lunch and a good book!
  8. Please try to refrain from any heavy chores such as cleaning the house or lifting heavy groceries, as well as strenuous exercise for at least one (1) week after your surgery.
  9. Please avoid alcohol for two (2) days after your surgery.
  10. If you have any questions prior to your surgery, please call our office.

Your Mohs Micrographic Surgery will be performed byDr. Ralph A. Massey himself. You will not be “passed on” to a training fellow or associate. All surgeries will be performed in Dr Massey’s outpatient office and surgery center located in Santa Monica and Encino, CA

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