Risks Of Mohs Surgery
As with any procedure, there are potential risks to Mohs surgery. Patients should carefully consider the following risks of this treatment:
- Bleeding, infection, itching, or numbness at the wound site
- Muscle weakness where the cancerous skin was removed
- Pain or soreness at the wound site and surrounding skin
- A thick scar remains at the wound site
Can skin cancer come back after Mohs surgery?
The type of skin cancer that was present can affect whether it will redevelop after surgery. The body can be fairly unpredictable, so its not easy to predetermine if cancer will reappear.
For basal cell carcinomas specifically, the recurrence risk after Mohs surgery is about 1%.
Mohs surgery has a high cure rate of 99% for new skin cancers that develop, and 95% for skin cancers that recur.
We are proud to perform the Mohs procedure, as this advanced treatment is highly effective for treating the two most common skin cancers, basal cell carcinoma, and squamous cell carcinoma, while only removing cancerous skin cells.
At UCF Health, we aim to educate our patients on the risks of skin cancer and ways to prevent this disease from developing. Our exceptional dermatologists have the expertise and experience you need to improve your skins health. When you schedule an appointment with our top-rated dermatologists in Orlando, you can rest assured that your greatest quality of life is our top concern.
What Is Mohs Surgery
Mohs surgery, also known as Mohs micrographic surgery , is a procedure used to remove skin cancer lesions or bumps from the body. Mohs removes affected tissue by cutting it out from the skin, leaving behind the healthy tissue.
Once the visible cancer has been removed, physicians will use a special dye to pigment the surrounding skin to see if there are remaining cancerous cells. If found, additional cutting will be needed. If clear, the patient will be deemed tumor free.
Mohs surgery does an excellent job at removing skin cancer, though it is labor intensive and often results in scarring and longer recovery times for the patient. Healing after Mohs surgery on the face can include lengthy periods of bruising, sensitivity, and scarring, with many patients seeking cosmetic surgery after Mohs to produce better visible results.
Want To Get Rid Of Skin Cancer Dont Leave It To Chance
Mohs micrographic surgery is a technique that requires expertise. If done right, it can make you cancer-free without having to worry about disfiguring scars. At BHSkin Dermatology, our award-winning dermatologists are the best in handling such a delicate procedure. Our patients are happy knowing that they chose the right specialists to deal with this problem. You may visit us at our Encino or Glendale clinic or use our virtual portal to consult with one of our doctors.
You are in good hands at BHSkin Dermatology. Book your appointment today!
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What Is The Post
Recovery following reconstruction of a post-Mohs wound depends on several factors, including the extent of the initial skin cancer removal, complexity of the reconstructive surgery needed, and whether multiple stages of reconstruction are needed. Our surgeons provide clear instructions to our patients and family members in regards to care of the surgical site, dressing changes, activity, limitations of activity, and precautions during the recovery period. Some temporary soreness following the reconstruction is expected. Often over the counter medications, such as Tylenol, suffice to alleviate discomfort. Depending on the extent of the procedure, pain medication may be prescribed to help with this. In regards to care of the surgical site, some procedures such as direct layered closure and many small flaps require very simple care and minimal or basic dressings, while other procedures such as more complex flaps or grafts require more attentive care and more specialized dressings to optimize early healing. Generally, healing time can vary from a couple of weeks for most direct closures and small flaps to 3 to 4 weeks for skin grafts to several weeks for more complex multi-staged procedures.
What Can I Expect The Wound To Look Like Or Feel Like The First Several Months Following My Surgery
The American College of Mohs Surgery reports that as your wound heals there may be a reddish appearance to the scar which is usually temporary. In addition the skin may contract and tighten and this usually occurs 4-6 weeks after surgery.
There may also be a bumpiness or hardening of the scar which is also usually temporary. Your wound may be red and raised for awhile but most scars will flatten and fade. It is estimated that this fading process will take anywhere from six months to a year.
What you will experience during the healing process may depend upon the area of the wound. For example, Dr. Ronald Shelton, a states that: “Swelling is more likely to occur around the eyes, as well as bruising. Lips tend to swell also. Ears may be more painful postoperatively than other sites.” As always it is best to consult with your doctor about what you can expect during the months after surgery as everyone will be unique in how they heal.
What Complications Can Arise From Having Mohs Surgery?
As with any type of surgery there are always risks for complications to develop. Cleveland Clinic’s information on Moh’s Surgery includes a list of potential risks which they say are mostly rare. These risks can include: Poor wound healing, excessive bleeding from the wound, infection, loss of nerve function, and cosmetic deformities.
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Can The Cancer Come Back
Mohs surgery has the highest cure rate of all treatments for basal cell and squamous cell carcinomas — more than 99% for new skin cancers and 95% if the cancer comes back.
Your doctor will want to schedule regular follow-ups with you to check your skin for new cancers. Twice a year is normal, but you may need them more often if the cancer is an aggressive type thatâs more likely to come back. You and your doctor will decide on the right schedule.
Frequently Asked Questions About Mohs Surgery
How Long Does the Surgery Take? You arrive for a morning or afternoon session and will generally be in the clinic for two to four hours depending on how many stages are required.
Am I Awake? Mohs surgery is performed under local anesthesia while you are awake. In between stages you will have a temporary bandage on, and you can sit up, talk, read and go the bathroom.
How Do I Prepare for Surgery?
Medications
- Take all of your medications as prescribed unless specifically instructed otherwise by a physician.
- Please let us know if you take any of the following blood thinning products : aspirin, Coumadin , Plavix , Vitamin E, Fish Oil.
- If you take ibuprofen or Naproxen on an as-needed basis, please stop these medications seven days prior to your surgery. If you take any of these medications by prescription, please discuss this with your prescribing doctor first.
- You may take Acetaminophen for pain during this period.
Alcohol Three days prior to surgery, we ask that you avoid drinking alcohol as it may increase your risk of bleeding.
Breakfast, Companions, Makeup and Books
Will I Have a Scar?There is always a scar after surgery. Your Mohs surgeon makes all efforts to hide the scar in the natural contours of your face and to preserve the shape and function of sensitive areas such as the nose and lips. Scars improve over weeks to months as scar tissue remodels, so it is important to give the scar time to “mature.”
What Can I Expect After Surgery?
Discomfort
Activities
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Apply Ice To The Wound
Just like you would apply ice to a bump on your head, you will apply ice to your surgical wound. Be sure to protect the wound from direct contact with ice, to avoid irritation. Hold the ice cubes or ice pack to the covered wound and hold it for at most 10 minutes. Remember, your skin in this area is delicate. Holding ice directly on the wound for too long can be very painful and ultimately do more harm than good. Applying ice over the first couple days following the surgery will help address any swelling and bruising.
Avoid Getting The Wound Wet For 48 Hours
While the bandage is on the wound, try to avoid getting the area wet. Water on a healing wound can be irritating and impede the healing process. Plus, a wet bandage doesnt provide protection and instead provides a perfect breeding ground for bacteria, which increases the chance of infection.
When can I shower after Mohs surgery? You can shower immediately following surgery, as long as you avoid getting the bandage wet. Most commonly, Mohs surgery will be performed on your face, making it easy to take a shower or bath without getting the surgical site wet.
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What Is The Purpose Of Mohs Surgery
Mohs surgery is a painstaking procedure. It requires microscopic analysis of tissue cells while the surgery is taking place. The borders of each thin layer of tissue are analyzed for potential malignancy as they are removed horizontally. This technique is designed to remove the entire tumor with minimal amounts of healthy tissue. This results in less disfigurement. For this reason, Mohs surgery is ideal for removing skin cancers from the face, ears, or genitals.
The procedure is highly effective for skin cancers that have high rates of recurrence. Its also effective on aggressive or large lesions. Mohs surgery is also used when lesions have ill-defined borders.
What Should Patients Expect About The Size Of A Skin Cancer Surgery Wound And The Resulting Scar
Its important to know that the wound that will be created during surgery on a BCC or SCC will be bigger than you might have guessed in advance, says Dr. Khorasani. For one thing, while your skin cancer may have looked like a small red spot when diagnosed, that can be just the tip of the iceberg. There may be extensions, or roots, of the cancer that are not visible from the surface that will be discovered during surgery, requiring the removal of more tissue.
Dr. Kober explains how a circular wound becomes a straight-line scar. If you try to bring that circle together, the two ends pucker up and become raised, she says. To correct for that, the surgeon has to remove those little puckers on either end. So before the wound is closed, the surgeon shapes the wound so it looks more like a football than a baseball . It does lengthen the scar, but it means that the scar lies flat and will look its best.
The ratio between the diameter of the circle to the length of the ellipse is 1 to 3, Dr. Khorasani explains. Therefore, if you do the math, the length of the scar will be about six times the diameter of the original lesion. The 10 fellows whom I taught Mohs surgery call this The Khorasani 1 to 6 Scar Rule, he says. They all still use it to educate their patients.
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What Else Can I Do To Minimize Scarring
Once new skin has formed, your dermatologist may suggest using a silicone-based scar gel. Research shows these products can help create softer, flatter scars. Dr. Platzer recommends Silagen gel, a 100% silicone gel with SPF 30. Available for purchase only at a doctors office, Silagen can be found at any Waters Edge Dermatology office.
After the sutures are removed, its important to use a broad spectrum sunscreen with SPF 30 or higher every day to prevent the new skin from darkening due to ultraviolet light exposure. It takes six months to a year for the scar to fully heal, said Dr. Platzer. Sunscreen will also help protect against future skin cancers.
Mohs Surgery Procedure: What To Expect
When you go in for your Mohs surgery, its helpful to have an idea of how the procedure goes.
First, your surgeon will meet with you to go over the procedure to make sure you know what to expect and what the goal of the procedure is. The surgeon will likely use a pen to mark the area that requires surgery.
You will not require general anesthesia for the surgery, which makes both surgery preparation and recovery easier. Before the procedure, your surgeon will simply clean the surgical site and apply a local anesthetic. Because you are receiving local anesthesia and not general anesthesia, you will remain awake and alert throughout the duration of the procedure, though you will not feel any pain.
When the surgeon has determined that the whole cancerous lesion has been removed, its time to close up the remaining area of skin. The way the wound is left is highly dependent on the area of skin that needed to be removed. The surgeon will address the area of skin and tend to the wound in a way that results in minimal amounts of scaring. In some cases, the surgeon may elect to leave the wound as is, to let it recover naturally. In other cases, the surgeon will manipulate the skin surrounding the surgical site and secure it over the wound with stitches. In other cases, still, a skin graft from an inconspicuous area of the body will be used to minimize scarring throughout the recovery process.
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Possible Skin Cancer Recurrence
Skin cancer has a very small chance of coming back after a Mohs procedure. However, when that happens, further tests may be done to look for sites of spread. Recurrences are treated immediately and with a regimen that may be more aggressive than the first.
Your primary doctor or dermatologist will schedule you for yearly follow-up visits to check for new skin cancer. They may also advise you about self-examination techniques. Self-examination can help you spot a recurrence or distant spread even before your scheduled follow-up visit.
Keep The Wound Covered With A Bandage
For the first 48 hours after Mohs surgery, or until your doctor has instructed, you should wear a pressure dressing over the surgical site. This type of dressing helps protect the wound from dirt while also applying pressure and absorbing any excess blood or fluid. Other types of bandages that may be used include silicone pads and oil emulsion-impregnated gauze. These ensure the bandage doesnt stick to the wound, helping reduce additional damage.
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How Much Do Patients Worry About Scars
When doctors tell patients they need skin cancer surgery, they hear a wide range of reactions, says Dr. Kober. I have some patients who say, I dont care about the scar, Doc. I dont have a modeling career. Just get the cancer out. Thats one extreme. There are also patients on the other side of the spectrum, she says, who are very concerned about the scar and its cosmetic appearance.
Hooman Khorasani, MD, former chief of the Division of Dermatologic & Cosmetic Surgery at Mount Sinai Medical Center in New York City, sees the full gamut of reactions in his private practice on the Upper East Side of Manhattan as well. That includes celebrity patients who know an unsightly scar could hurt their career. Dr. Khorasani, who is quadruple board-certified in dermatology, Mohs surgery, cosmetic surgery and facial cosmetic surgery, spends about 50 percent of his time doing Mohs surgery and says hes careful to reassure patients as well as manage their expectations. Most cases are BCCs and SCCs. When detected early, theyre almost always curable. I explain to patients that these are very common skin cancers and that theyre not alone, he says. Were definitely going to take care of it and get rid of the cancer. Thats the most important thing. He knows the importance of a good cosmetic outcome, too. In fact, hes done extensive research on minimal scar wound repair.
What Should I Expect After Mohs Surgery
Some post-operative swelling, bruising and minor discomfort is normal and can be managed with an over-the-counter pain reliever such as Tylenol. I normally dont prescribe any post-op pain medication, said Dr. Platzer. These symptoms usually resolve within 48 to 72 hours. Applying ice or a cold compress for 20 minutes every hour can help reduce inflammation and swelling. The cold also makes the nerve endings less sensitive to pain. Depending on the location of the surgery, the sutures will be removed in seven to 14 days.
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Can Mohs Surgery Cause Nerve Damage
With any skin surgery, there are potential areas where nerve damage could occur. Anytime we consider surgery, we counsel our patients that there are tiny sensory nerves in the skin. Often those sensory nerves are impacted. The good news is, many of those sensory nerves regenerate over time.
In the majority of skin cancer surgery, there is no motor nerve involvement. Motor nerves are nerves that move muscles. Depending on where the skin cancer is, how deep it is and how aggressive it is, sometimes the cancer can involve motor nerves. If there’s any risk of affecting motor nerves, we discuss the expected outcomes before surgery begins. If the cancer does involve a motor nerve, it can sometimes regenerate. Other times we can use surgical and non-surgical modalities to help the body compensate.
Will Mohs Surgery Leave A Scar
All types of surgical skin cancer removal techniques cause some scarring. Mohs surgery is particularly beneficial for the face and other high-visibility areas because it leaves more healthy tissue intact compared to other skin cancer removal techniques like a simple excision with a small blade. The size of your scar depends on the size of the cancer and how deeply it extends into the skin.
If you are anxious about scarring, talk to your dermatologist well in advance of surgery. Take the time to discuss your options, including whether or not you will need more advanced reconstructive surgery to repair the wound. You can also explore the possibility of having a plastic surgeon close the wound after the surgery.
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