Here’s What to Expect During Your Mohs Surgery

As the most common form of cancer in the United States, skin cancer affects millions of adults at any given time. About 9,500 Americans are diagnosed with skin cancer every day, and one in five people — or 20% of the US population — develops the disease during their lifetime.

Fortunately, most skin cancers have a high cure rate when detected early and treated promptly. Routine skin cancer screenings can improve the likelihood of catching basil cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma tumors early. Similarly, precise removal techniques help ensure complete eradication with minimal disruption to healthy skin tissues. 

Our expert team of board-certified dermatologists at Florida Dermatology Associates specializes in Mohs micrographic surgery — a minimally invasive skin cancer removal technique that meticulously extracts cancer cells, while sparing as much healthy skin tissue as possible.

Read on to learn more about this exacting skin cancer treatment, and find out what you can expect during the procedure. 

Mohs micrographic surgery explained

Founded in the 1930s by the general surgeon and cancer researcher Dr. Fredric E. Mohs, Mohs micrographic surgery was conceived and developed as an ultra-precise technique. Nearly a century later, Mohs surgery remains the gold-standard treatment for skin cancer removal. 

The Mohs technique precisely eliminates skin cancer cells while preserving as much healthy tissue as possible. It contrasts with other surgical excision techniques, which aim to ensure complete removal by cutting away a wide margin of healthy skin tissue along with the cancer tumor. 

During Mohs micrographic surgery, our team:

• Removes the visible part of the cancer tumor along with a small margin of surrounding skin tissue
• Carefully examines the marginal tissue for cancer cells before deciding whether to remove another skin layer
• Continues the process in stages, removing and examining thin layers of marginal skin tissue until no more cancer cells are detected

Through exacting precision, Mohs micrographic surgery aims to remove all cancer cells while conserving healthy tissues. This advanced technique makes it possible to remove cancer tumors — including lesions with irregular borders and aggressive tumors that spread inward like tree roots — while leaving healthy surrounding tissues mostly untouched. 

Because the Mohs technique causes minimal disruption to healthy tissues, it’s an excellent treatment approach for skin cancers in sensitive areas like your face, eyelids, nose, fingers, toes, or genitalia. 

What to expect during Mohs surgery

Undergoing any surgery can be stressful, but you may feel particularly wary of a procedure routinely described as “painstaking” and “methodical.” However, most Mohs surgery patients are happy to find out that the most challenging thing about this diligent skin cancer removal technique is the amount of time it can take. 

Mohs micrographic surgery is a pain-free outpatient procedure that we perform at one of our offices. After cleansing and disinfecting your skin, we administer a local anesthetic to numb the treatment area and keep you comfortable. Next, we meticulously remove the skin cancer cells in four basic steps:

Step 1

First, we excise the portion of the skin cancer tumor that’s visible without a microscope. 

Step 2

Next, we remove a thin layer of margin skin tissue from around the previously biopsied tumor, marking both the tissue sample and the surgical site for reference. 

Step 3

Then, we place the excised skin tissue in a microscope slide and carefully examine it in our on-site lab. If we find cancer cells, we map their locations to pinpoint their exact positions relative to the corresponding adjacent tissue at the surgical site. 

Step 4

We repeat steps two and three as necessary, but only for the skin tissue sections that contain cancer cells. In some cases, Mohs surgery takes just one stage to complete, meaning the first layer of surrounding skin tissue is clear of cancer cells.

Multiple rounds

More often, it takes up to three rounds of meticulous skin tissue excisions and examinations to reach clear, cancer-free tissue. It only takes a few minutes to remove the thin sample, but it can take up to an hour to analyze it properly. Before each consecutive round of surgery, you may receive another anesthetic injection to ensure optimal comfort.

Finishing the process

Depending on the extent of your procedure, your surgical site may be left to heal naturally, closed with stitches, or repaired with a skin graft taken from another area of your body. Small, shallow wounds usually heal well without stitches, while larger or deeper wounds typically require some form of medical closure.

If you have questions about Mohs micrographic surgery, we have answers. Call or click online to schedule a visit today at one of our five office locations throughout southeastern Florida in Palm Bay, Cocoa Beach, Cocoa, Melbourne, or Titusville, Florida.