Soft Tissue Reconstruction (Mohs Reconstruction)

What is Mohs Surgery or Reconstruction?

Mohs micrographic surgery is considered the most effective technique for treating many basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), the two most common types of skin cancer. The procedure is done in stages, including lab work, while the patient waits. This allows the removal of all cancerous cells for the highest cure rate while sparing healthy tissue and leaving the smallest possible scar.

It began as a technique called chemosurgery, developed by Frederic E. Mohs, MD, in the late 1930s, but was not widely known. In the mid 1960s, Perry Robins, MD, became the first dermatologist to study the technique with Dr. Mohs, and he helped advance the procedure into what is now called Mohs micrographic surgery.

Mohs surgery is performed by doctors who are specially trained to fulfill three roles:

as the surgeon who removes the cancerous tissue
as the pathologist who analyzes the lab specimens
as the surgeon who closes or reconstructs the wound

Advantages of Mohs Surgery

Efficient, cost-effective treatment:

Single-visit outpatient surgery
Local anesthesia
Lab work done on-site

Precise results:

Physician examines 100% of tumor margins
Spares healthy tissue
Leaves the smallest scar possible

The highest cure rate:

Up to 99% for a skin cancer that has not been treated before
Up to 94% for a skin cancer that has recurred after previous treatment

The procedure is done in stages, all in one visit, while the patient waits between each stage. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. The doctor repeats this process until no cancer cells remain.

Mohs surgery is the gold standard for treating many basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), including those in cosmetically and functionally important areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also recommended for BCCs or SCCs that are large, aggressive or growing rapidly, that have indistinct edges, or have recurred after previous treatment.

What to expect before, during, and after Mohs Surgery

Since doctors first began treating skin cancer, their techniques for removing tumors have evolved rapidly. There have been many valuable improvements over the years, but Mohs micrographic surgery has truly stood the test of time — it’s come to be accepted as the gold standard for removing the two most common forms of skin cancer, basal cell carcinoma and squamous cell carcinoma. It offers the highest cure rate while sparing as much healthy tissue as possible.

The Preparation

Once you’re scheduled for Mohs surgery, it’s important to take note of any existing health conditions. For example, if a patient has a heart murmur or artificial joint, they should speak with their primary care physician to determine if preoperative antibiotics are necessary.

If you have preexisting cardiovascular disease, it’s important to speak with your doctor as well — he or she may or may not instruct you to discontinue any blood thinners.

For those without any preexisting conditions, there are still a handful of things to keep in mind. It is recommended to avoid aspirin and other nonsteroidal anti-inflammatory drugs (including ibuprofen) for at least 7 days prior to your surgery. Avoid alcohol and vitamin E a few days before as well. A good night’s sleep and a normal breakfast are the way to go the day of the procedure. There is no need to fast, since local anesthesia is used for the surgery.

It’s best to clear your schedule the day of your Mohs procedure, as the process can take time. You may want to ask a loved one to accompany you to your appointment. Finally, if the surgery is on your face, make sure your skin is free of makeup.

The Procedure

Though undergoing surgery of any kind can be nerve-racking, a Mohs procedure shouldn’t involve a huge amount of pain or inconvenience. The procedure itself is usually much easier than patients anticipate.

The local anesthesia injection of which is generally the most painful part of the experience. Once the area is numb, you may feel some pressure as the surgeon works, but removing the first specimen takes only a few minutes. Tissue processing usually takes an hour or two, though, so you may want to bring a book or magazine to pass the time.

About 40 to 50 percent of the time a Mohs procedure is finished in the first stage. If the tissue sample doesn’t come back clear of cancerous cells, the patient will receive more anesthesia and repeat the process. Once the site is clear of cancer cells, the wound may be left open to heal or the surgeon may close it, depending on its size and location.

Beyond the possibility of pain, many patients have cosmetic concerns about the surgery. They worry it will leave a noticeable scar. Though a patient and their family members may always be able to tell they’ve had the surgery, typically it will be difficult for others to notice anything amiss after they’ve completely healed.

Recovery

At Cimisurgical we provide explicit post-op directions, so you won’t need to guess at how to recover most effectively. You’ll likely be instructed to avoid strenuous work or exercise for at least 24-48 hours, and told the possible warning signs of wound infection.

Some patients may experience a little discomfort —maybe including some bruising and swelling — but these symptoms usually resolve fairly quickly. If you’re dealing with pain after the procedure, we suggest trying a cold compress, over-the-counter pain medication, and lots of rest. Before you leave your doctor’s office, be sure to know whom to call if you have any concerns outside of office hours.

It’s important that you follow your doctor’s instructions for wound care, scar care and follow-up to achieve the best possible outcome.