Mohs Surgery is a type of advanced skin cancer treatment generally used to treat SCCs (squamous cell carcinomas) or BCCs (basal cell carcinomas). It works to treat skin-based cancer issues using medical and cosmetic surgery steps. Most skin cancers cannot benefit from Mohs surgery, but it effectively removes total facial-based skin cancer cells with clear-cut margins.
The success rate of this surgical procedure is high, with a 95% success rate for recurring cancers and a 99% rate for new cancer. In addition, it is effective in treating larger tumors with 2 cm diameter or aggressive histological tumors, or those that occur in embryological facial cleavage plans, like behind/front of the ear or nose creases.
Mohs Micrographic Surgery
Facial skin; around the lips, eyes, ears, fingers, nose, fingers, genitals, and toes
How Mohs Surgery Performed
During the surgical procedure, the surgeons mark the zones/margins of the tumor. Next, the anesthesiologist in the team administers local anesthesia in the region. Then, the surgeon resects a narrow 0.5 mm to 2 mm margin of the tumor. Finally, they apply an electric current to stop bleeding from the capillaries.
The wound dries up, and the team dresses it with a more significant pressure dressing. Then, the patient can return to their examination room, where the team sends the color-coded specimen to the lab for evaluation. The lab technicians use microscope slides using microtomes for the surgeons to examine. Dermatologists in the team also process and evaluate the pathology site to check for tumor recession.
If no tumor is left in the region, the doctor will conduct delicate plastic-centric surgical wound reconstruction in the operating theatre. However, if tumor specimens remain, the patient would undergo additional tissue removal surgery from the region that has the roots. Usually, it takes two rounds to detect and remove the skin cancer tissues under Mohs surgery.
Preparation for Mohs Surgery
There are not many preparation-based steps that patients have to handle since the main procedure completes in a single visit under stages. However, you have to wait between these stages as the surgeon checks the cancer cell positioning in the lab on-site. The necessary preparation steps involve:
The patients must wear soft and comfortable clothing for a smoother skin tissue removal and examination process. You can wear breathable fabric-made clothing for more accessible spot marking and tissue removal. Alternatively, wearing a hospital gown is also suitable for a more extended stay at the facility.
The doctor would check the area of a previous biopsy during the Mohs surgery for easier marking. So, it would help if you lay face up or sit up for easier access.
Procedure for Mohs Surgery
Mohs Surgery Follow up
Generally, the surgical wounds during the Mohs surgery are not sutured up. Instead, the round wounds are left to heal naturally; this process takes longer. The surgeons can also use the Mohs reconstruction surgery steps to manually close the surgical defect using skin grafts or skin flaps.
In some cases, the surgical wounds are big or have more complications. Doctors suture them up temporarily and then later conduct repairs via a reconstructive surgeon. Keep the pressure dressing on the affected region for at least 24 hours after the surgery.
Clean the area with mild soap and water gently during the bath, and apply antimicrobial medication on the wound before dressing it again. Keep the area elevated during sleep and have oral antibiotics that the doctor prescribed to avoid infections. Also, do not apply any harsh chemicals or makeup on your skin.
Risks of Mohs Surgery
There are not many complications possible after Mohs surgery if you go to a trained surgeon for the procedure. However, some risks are possible:
Some patients notice hypersensitivity to certain medications during the Mohs surgery. That causes skin reactions.
The skin can bruise or swell up after the procedure for some patients.
Bruises or bleeding are possible. Severe pain and infections are common risk factors, further leading to scarring.
Some patients notice prolonged healing in the affected region after the procedure.
Recovery for Mohs Surgery
The recovery from the Mohs surgical procedure depends on how well the wound heals. It takes around 1-2 weeks for the small incisions that are sutured up to dry and then close up. For other incisions, the healing period can take around 3 to 4 weeks.
Big wounds take longer to heal up, or applying heavy pressure on the affected region can also slow healing. So, it would help if you avoid heavy lifting or excessive movement to let the skin heal properly. Also, avoid smoking and cover the facial skin from extreme sun exposure.
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