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Mohs Micrographic Surgery |
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Kathleen Behr, M.D. |
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What is Mohs surgery? Mohs surgery is a highly specialized treatment for the total removal of skin cancer. This method differs from all other methods of treating skin cancer by the use of Complete Microscopic Examination of all the tissues removed surgically as well as detailed mapping techniques to allow the surgeon to remove all the roots and extensions of the skin cancer.
The procedure begins after the skin is injected with a local anesthetic to make it completely numb. Then the visible cancer and a very thin layer surrounding the skin are removed with a scalpel, carefully mapped, and examined microscopically. If there is still cancer seen under the microscope, another very thin layer of skin is removed from that exact location. This may be repeated as often as necessary to completely remove the cancer.
What are the advantages of Mohs surgery? By using these detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The result is: (1) the removal of as little normal skin as possible and (2) the highest possibility for curing cancer.
What is the cure rate? Using Mohs surgery, the percentage of cure is more that 99 percent for most skin cancers, even when other forms of treatment have failed.
Is hospitalization necessary? No. Mohs surgery is performed in a pleasant outpatient surgical suite and you may return home the same day. Hospital facilities are available in the area if necessary.
Preparing for the surgery: Continue any medications prescribed by your doctor. However, aspirin is a drug that may prolong bleeding. We ask that you avoid aspirin (including Anacin, Bufferin, Excedrin, Alka Seltzer, Percodan, Motrin, Advil, and Naprosyn) for one week prior to surgery unless otherwise advised by Dr. Behr. If you are taking any blood thinners (Coumadin) please call our office before your scheduled surgery. In addition, alcohol will also promote bleeding, so avoid alcoholic beverages 24 hours before surgery.
We suggest that you arrange to have a companion drive you to and from the doctor’s office.
The day of the surgery, we suggest that you eat a normal breakfast. Wear comfortable clothing and avoid “pullover” clothing. If operating on the face please do not wear make-up on or around the area.
On the day of the surgery: Your appointment will be scheduled in the early morning. The area around the skin cancer will be anesthetized. This will feel like a pinch but will not be painful because we use both refined micro-injectors and a local anesthetic solution that causes very little stinging.
The surgical procedure takes only 10-15 minutes. However, it takes a minimum of 60 minutes to prepare and microscopically examine the tissues. Several surgical stages and microscopic examinations may be required, and you will be asked to wait between stages. Although there is no way to tell before the surgery how many stages will be necessary, most cancers are removed in three stages or less.
We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material to occupy your time while waiting for the microscopic slides to be processed and examined. Magazines will be available in the waiting room area. You may bring snacks and drinks to enjoy while you are waiting.
The most difficult part of the procedure is waiting for the results of the surgery. Since we don’t know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you make no other commitments for the entire day that you are scheduled for surgery.
Will the surgery leave a scar? Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we may choose (1) to leave the wound to heal by itself, (2) to repair the wound with stitches or (3) to reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result. We may advise a touch-up surgery later with the laser or dermabrasion to improve any visible marks. We will use the same cosmetic surgery techniques we use to erase wrinkle lines and improve any scar.
Will I have pain or bruising after the surgery? Most patients do not complain of pain. If there is discomfort, Tylenol or Acetominophen is all that is usually necessary for relief. If larger repairs are done a pain medication may be prescribed. Avoid taking medications containing aspirin (see preparing for the surgery above) as they may cause bleeding. You may have some bruising around the wound especially if the surgery is close to the eye.
Will my insurance cover the cost of the surgery? Most insurance policies cover the cost of Mohs surgery, however, you should check with your carrier for exact information related to their schedule of payments. On your first visit please bring a copy of your I.D. card, group number, policy name, and correct mailing address of your insurance carrier. We accept assignment on Medicare.
Will I need to come back? Usually, one return visit is all that is needed to examine the healing surgical site or to remove stitches. Afterwards, you may return to your referring physician for routine check-ups.
A follow up period of five years for the treated cancer is essential. After having one skin cancer, statistics show that you have a greater chance of developing a second skin cancer. You should have your skin checked by your referring physician at least once each year, not only to examine the treated skin cancer, but also to check for new skin cancers.
How can I protect myself from developing more skin cancer? The best protection from skin cancer is to avoid the harmful ultraviolet rays of the sun. Even if you tan easily, the sun can contribute to skin cancer in two ways. First, the sunlight damages the genes that control cell growth, and second sunlight damages the body’s immune system so that early cancers grow unchecked by normal immune defense.
Minimize your exposure by:
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Frequently Asked Questions |
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· Using sunscreen with a sun protective factor (SPF) of at least 30 when you spend any time in the sun. The sunscreen should block both UVA and UVB rays.
· Avoid sun exposure during midday hours (10:00 a.m. to 2:00 p.m.).
· Do not stay outdoors unprotected on cloudy days since the ultraviolet light penetrates easily through the clouds.
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