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Mohs Surgery On The Face

Mohs Surgery Vs Excision: Whats The Difference

Mohs Micrographic Surgery: Smaller Scars, High Cure Rate

Excision is a procedure through which your surgeon removes the skin cancer and a margin of surrounding skin and the specimen is sent to pathology for processing and interpretation. In general, less than 1% of the margins are checked with wide local excision. . Mohs micrographic surgery involves excision with a smaller margin and the tissue is processed in such a way that your surgeon checks 100% of the deep and side margins.

Aftercare: What To Know About Facial Mohs Surgery

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Having any kind of surgery can be overwhelming and with skin cancer often being found on the face, it can even be frightening. You may be wondering what to do for aftercare, if youll have a scar, and if so, how bad it will look? Fortunately, Mohs surgery is an effective treatment for most types of skin cancer and your doctor will be able to help you with reconstruction options if there is scarring.

Here is information on Mohs surgery aftercare and what to expect after your surgery.

The Mohs Micrographic Surgery Experience: The Takeaway

Mohs surgery is the gold standard of skin cancer removal treatments. Its cure rates and esthetic outcomes are superior compared to its alternatives. But only a bona fide Mohs surgeon can perform it because of its complexity.

Patients can avoid complications with good pre-surgical preparation and aftercare. Sun protection, carcinogen avoidance and regular self-skin checks and dermatology visits help prevent relapses and severe illness. Most importantly, to ensure the success of your procedure, trust only a bona fide Mohs surgeon.

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What Can Be Done To Help My Scar Look Better After It Heals

If your skin does not heal as well as you would like, there are treatments you can discuss with your doctor to lessen your scar. These include:

  • Lasers, which are used to reduce redness and smooth the texture of the skin
  • Dermabrasion, which is like polishing the skin to even it out
  • Scar removal or revision
  • Creams and ointments to thin the skin
  • A combination of these treatments

Can You Drive Home After A Mohs Procedure


For most patients, it is safe to drive home after the operation. Local anesthesia does not cause drowsiness, and the surgical wound is not expected to restrict body movement.

Still, if this is a concern, you may discuss it with your surgeon before you get discharged. At BHSkin Dermatology, patient safety is our top priority. Our doctors will give you a quick, thorough check before clearing you for driving and sending you home.

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Is Mohs Surgery Just For The Face

  • Posted on: Jul 15 2022

Of all cancers that affect millions each year, skin cancer is the most common type, by far. Within skin cancer itself, two types account for nearly all skin cancer cases, basal cell carcinoma and squamous cell carcinoma. Especially with recent advancements in medical technology, early detection and treatment can lead to a nearly 100% success and recovery rate.

One treatment that has been recently considered to be the gold standard in skin cancer treatment, Mohs surgery is a procedure that was developed as the result of a laboratory accident. During a study in the 1930s of cancers and healthy tissues in rats, Dr. Fredric Mohr inadvertently injected a strong solution of zinc chloride into the study tissue.

Not only did the zinc chloride cause necrosis of the tumor and surround healthy tissue, it preserved the code markers of cancerous cells in the same way as if the tissues were stored in a solution for many hours.

This discovery of a way to instantly see if cancerous cells exist, was developed into a procedure that allows for real-time examination of excised layers of cancerous skin to clear all but healthy tissue. Dr. Mohr first realized the full potential during the removal of an eyelid carcinoma. Seeing the results, he then selected it as the treatment procedure for 66 eyelid carcinomas in 1969, with an astonishing 100% 5-year cure rate.

Discovering A Treatment Without Surgery

Thirty years ago, Ruby was diagnosed with skin cancer after years of playing tennis outside. At that time, her only treatment option was Mohs surgery. Ruby was diagnosed with skin cancer again in 2019. She was happy to find out from her doctor about a newer treatment with no surgery: Image-Guided SRT.

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Ongoing Research And Proven Results

We recently completed a study, published in the Journal of the American Society of Plastic Surgeons, on the safety of outpatient scalp reconstruction after Mohs surgery for basal cell carcinoma, squamous cell carcinoma, melanoma, and other skin cancer types.

Analyzing data from 913 scalp reconstruction procedures performed over 10 years, we showed that transplanting a patients own adjacent skin as a deep tissue graft or placing an Integra dermal regeneration template is safe and effective under local anesthesia, even among elderly patients with more fragile skin. Previous research weve co-conducted has also shown that outpatient reconstruction surgery is safe for the nose, ear, and lip.

Eating A Balanced Diet

Reconstruction After Mohs Surgery | Amber’s Story

A balanced diet is important for promoting optimal wound repair. Even though a Mohs surgery wont impact your daily life like a more invasive surgery would, its still important to follow a balanced diet to support quick and complete healing of the surgical site.

So, what exactly does it mean to eat a balanced diet? Generally, following a balanced diet means youre getting whole foods from each food group.

Its important to get plenty of fruits and veggies. Fresh produce is packed with vitamins, minerals, antioxidants, and fiber that help support the healing process. In particular, polyphenols and vitamin C help reduce inflammation and oxidative stress and support cellular repair. To encourage timely healing add plenty of fruits and veggies to your diet on a daily basis. Excellent food choices include produce like apples, blueberries, oranges, mango, cherries, carrots, tomatoes, beets, bell peppers, cucumber, spinach, kale, broccoli, and Brussels sprouts.

Whole grains, nuts, and seeds also provide an abundance of antioxidants, vitamins, and minerals that are vital for healing and repair.

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Why Is It Called Mohs Surgery

The procedure was developed by Frederic E Mohs, MD, in the 1930s and has since been refined. Originally, Dr. Mohs injected the tumor with a preserving chemical so that when removed , he could inspect the tissue under a microscope. But the initial process of preparing fixed-tissue slides took several days, the use of chemicals to cauterize the tumor was controversial and the procedure was painful.

About 20 years passed before Dr. Mohs and his colleagues tried a new technique to remove carcinoma from an eyelid: the surgery could be done in one day using frozen fresh tissue in slide preparation.

How Mohs Surgery Works

Sometimes known as Mohs micrographic surgery, the technique was invented in the 1930s by Dr. Frederic Mohs at the University of Wisconsin, but it didnt develop into a mainstream treatment until practitioners such as NYU dermatologist Perry Robins, MD, refined the technique and spread the word about it in the 1970s and 1980s. The use of Mohs surgery has especially been growing in the past 15 years, above all for skin cancers in the head and neck region.2-5

The most obvious difference between Mohs surgery and routine excisional surgery is that Mohs is done in stages while you wait for lab results, which are obtained immediately on site, rather than the tissue sample being sent to a lab for results days later.

A surgeon specially trained in Mohs surgery, pathology and reconstructive surgery first may draw some marks around the lesion with ink to guide the treatment, then injects a local anesthesia. Using a scalpel, the doctor removes the thinnest possible layer of visible cancerous tissue. A nurse or assistant bandages your wound and shows you to a waiting area.

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When Do You Have It

Mohs micrographic surgery is most useful for:

  • basal cell cancers that have come back after removal or have not been completely removed
  • basal cell cancers that have grown in an area that has had surgery or radiotherapy before
  • basal cell cancers that are growing into surrounding skin tissue
  • large skin cancers where removing as little of the healthy skin tissue as possible can mean a smaller scar
  • cancers in areas where it’s important to remove as little tissue as possible: for example, near the eyes, lips, ears or nose
  • some rare skin cancers

Younger People Benefit Too

Mohs Surgery for Skin Cancer

The number of people who develop skin cancer has been increasing for decades, and, alarmingly, more women and men under age 40 are now being diagnosed with the disease. Particularly in women, indoor tanning has been linked by many experts to an increased incidence of skin cancers at younger ages.

In my practice, I treat at least one patient in his or her 30s each week with Mohs surgery and many in their 40s and 50s, which is vastly different than 20 years ago, when the majority of patients were older. Not many young people seriously worry about getting skin cancer. Many use tanning beds and skip sun protection, and if they discover an unusual growth on their skin, they often delay seeking treatment because they think its no big deal. But it can be. Basal cell carcinomas rarely metastasize, or spread through the body, but some have aggressive growth patterns and can cause significant damage by growing along nerves or blood vessels, or through muscle or bone. By allowing the cancer to grow, you risk requiring more extensive surgery in the future. Squamous cell carcinomas can be more dangerous, carrying an approximately 4 percent risk of metastasis and 2 percent risk of death6, and the risk increases when these cancers return after treatment.

Arielle N.B. Kauvar, MD

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Why Mohs Surgery Is The Best Option For Skin Cancer Removal

  • Posted on: Oct 15 2022

Mohs surgery is a type of skin cancer treatment that removes thin layers of cancerous tissue. The tissue is then examined under a microscope to determine if cancer has been completely removed.

This surgery is often used for large, aggressive cancers or difficult-to-treat areas. It is also the most effective skin cancer treatment, with a cure rate of 99%.

If you or someone you know has been diagnosed with skin cancer, Mohs surgery may be the best treatment option. Keep reading to learn more about this life-saving surgery!

What Happens After Mohs Surgery

Mohs surgery is still surgery, and all surgeries remove skin and leave some sort of wound. So once the skin cancer is completely removed, the Yale Medicine dermatologist will have a discussion with you about surgical reconstruction. We talk about what’s involved with plastic surgery and what’s involved with letting the area heal naturally, says Dr. Leffell. We prefer to take a minimalist approach and let the patient decide what they want us to do and how they want to let their skin heal.

If the spot was small and superficial, the best approach may be to let the area heal naturally. That can take three to four weeks, but the area may remain red for some time after that, Dr. Leffell says. Patients can choose to apply makeup, but they should not expect the best cosmetic result to occur until nine to 12 months have passed, he says.

In situations where more skin is removed, there may be a need for plastic and reconstructive techniques to restore the appearance and function of the area .

The Mohs surgeons at Yale Medicine are specially trained in plastic reconstruction of facial wounds, Dr. Leffell says. The vast majority of plastic surgery is done by the Mohs surgeon at the time of the Mohs surgery. Similarly, it is done under local anesthesia in the office.

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What Are The Side Effects Of Image

As with any medical procedure, there are some potential side effects of Image-Guided SRT.

  • The most common side effects are usually mild to moderate irritation, redness, thinning, or breakdown of the skin that was treated, which may increase the risk for a skin infection.
  • These side effects can be cared for by your doctor and usually go away within 2 to 6 weeks after treatment ends.
  • Some people may notice that the skin that was treated becomes darker or lighter. Hair loss may also happen to the skin that was treated.
  • Rare side effects include a skin ulcer that does not heal and another cancer forming in the same area 20 to 40 years after treatment

Process Of Mohs Surgery

Mohs Surgery: Neck, Face and Head

Mohs surgeons do the Mohs surgeries these surgeons are dermatologists by profession. While they do the surgery, most patients are alert and awake. Therefore, this treatment can be done easily and safely in a surgical suite or a medical office. However, if they schedule an extensive surgery, youd be admitted to a hospital.

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When Is Mohs Surgery Not Recommended

The following are the contraindications of the Mohs procedure:

  • Health conditions impairing the wound healing process. They include advanced diabetes mellitus, clotting disorders, immunosuppression, poor blood circulation in the problem area, anemia and many others
  • Severe infection
  • Mental health conditions that can make awake patients uncooperative
  • Tumor involvement of vital structures, e. g. bones, nerves, eyes, etc.
  • A history of severe allergy to local anesthesia, latex or any other materials used during surgery
  • Severe cardiovascular or lung disease
  • Patient refusal

People with chronic conditions are generally advised to get medical clearance, which lets them know if they can tolerate Mohs surgery. The procedure is not contraindicated in pregnancy. But expectant moms must have no other health problems or be medically cleared before their Mohs appointment.

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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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.

What Happens During Mohs Surgery

Figure 3 from Scar Revision and Recontouring Post

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.

Step 1: Examination and prep

Depending on the location of your skin cancer, you may be able to wear your street clothes, or you may need to put on a hospital gown. The Mohs surgeon examines the spot where you had your biopsy and may mark it with a pen for reference. The doctor positions you for best access, which may mean sitting up or lying down. A surgical drape is placed over the area. If your skin cancer is on your face, that may mean you cant see whats happening, but the doctor talks you through it. The surgeon then injects a local anesthesia, which numbs the area completely. You stay awake throughout the procedure.

Step 2: Top layer removal

Using a scalpel, the surgeon removes a thin layer of visible cancerous tissue. Some skin cancers may be the tip of the iceberg, meaning they have roots or extensions that arent visible from the surface. The lab analysis, which comes next, will determine that. Your wound is bandaged temporarily and you can relax while the lab work begins.

Step 3: Lab analysis

Step 4: Microscopic examination

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Keep An Eye Out For Signs Of Complications

Because Mohs surgery is a small, topical procedure, you arent at risk for serious or life-threatening complications. However, as with any procedure, bleeding and infections are potential complications. You may notice an issue with bleeding if blood soaks all the through the bandage. Keep in mind that you are at a higher risk of bleeding complications if you take blood thinners.

Signs of infection include oozing at the surgical site, redness and warmth around the surgical site, swelling, itching, and irritation. If you notice any signs or symptoms of complications, its important to call your doctor and take care of the issue as soon as possible.

Mohs Surgery For Melanoma In Situ Where We Stand

10 June 2019 | Melanoma Stories, Science

You were just diagnosed with stage 0 melanoma, or melanoma in situ, on the tip of your ear. You learn that you are lucky and that your melanoma was detected before it had time to spread throughout your body. A surgery to remove the melanoma is quickly scheduled, and you take a deep breath and try not to think of what you narrowly avoided.

The most widely performed surgery to treat melanoma in situ is called a wide local excision where a surgeon removes the tumor with a margin of clear-looking skin of .5 1 cm. The wound is then stitched together. This technique has proven to be effective at curing melanoma in situ in most patients.

While effective and time tested, the procedure can cause significant scarring and even loss of function when performed in delicate areas. For non-melanoma skin cancers, such as basal cell carcinomas and squamous cell carcinomas, an alternative tissue-sparing procedure is frequently performed called Mohs Micrographic Surgery. Mohs Micrographic Surgery, frequently shortened to just Mohs surgery, was developed in the 1930s by Dr. Frederic Mohs, Professor of Surgery at the University of Wisconsin.

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