MARGARET S. LALLY M.D.

Skin Cancer: the most common form of cancer

1 in 5 Americans will develop skin cancer in their lifetime. Risk factors include fair skin, history of sun exposure, history of transplant or immunosuppression, and family history of skin cancer. The most common forms of skin cancer are basal cell cancer, squamous cell cancer, and melanoma. When caught early these skin cancers have a high cure rate. Basal cell and squamous cell carcinoma rarely metastasize to other parts of the skin or lymph node, however if left untreated they can be locally aggressive and cause discomfort such as pain and bleeding.

 

What is Mohs micrographic surgery

Mohs surgery was developed by Dr. Frederic Mohs in the 1930’s as a way to remove skin cancers ensuring the 100% of the margin is clear. The process allows a Mohs surgeon to preserve as much normal skin as possible while ensuring all of your skin cancer is removed, giving the procedure a cure rate of 97-99% and allowing a superior cosmetic outcome.

Mohs surgery is performed in the office under local anesthesia. Once the area around the tumor is numbed the visible tumor is removed and a small margin around that tumor is taken. The tissue is taken to the Mohs lab and processed, placed on slides, and then stained. Your Mohs surgeon will read the slides and if there is any residual skin cancer left they will remove more skin in the location of positivity. The process repeats until all the cancer is gone. Your Mohs surgeon will then close the wound with stitches or allow it to heal on its own.

 

Why Mohs surgery?

-Cure rates for Mohs surgery are 97-99% for primary tumors and 95% for recurrent tumors (tumors that had been treated in the past and recurred)

-Removal of the tumor and closure of the wound is performed in the same day under local anesthesia. In rare cases repair of the wound will be coordinated with oculoplastics, ENT, or plastic surgery and general anesthesia may be necessary

-Mohs surgery is the most cost effective form of skin cancer removal.

 

How long will Mohs surgery last?

Length of Mohs surgery will depend on each individual skin cancer. While most procedures take 3-4 hours it is possible the procedure will take all day. We kindly ask you to prepare to spend the day with us, we welcome you to bring reading materials or anything that will make you time in our office more comfortable.

 

Will I have stitches following surgery?

Depending on your wound following Mohs surgery you may have no stitches, one layer of stitched, or two layers of stitches. Your Mohs surgeon will review all repair options prior to placing stitches, this may include a straight line closure, graft, or moving adjacent skin into the open wound.

 

Will I have a scar after the surgery?

You will have a scar following surgery, however your Mohs surgeon will ensure the wound and scar are as small as possible to achieve the best cosmetic outcome.

 

Will I be put to sleep for surgery?

Mohs surgery is performed under local anesthetic, you will not be put under general anesthesia for the procedure.

 

Should I bring someone with me?

It is recommended you have someone with you to drive you home after your procedure. Mohs surgery can cause swelling around the eyes making it difficult to see. Additionally, the 48 hour pressure dressing may limit your ability to wear glasses.

 

Should I take my regular medications prior to surgery?

Yes, please take all your regular medications prior to coming for your surgery unless directed not to be our office. If you have questions about what is ok to take and what is not please call our office prior to your surgery and we will be happy to answer any questions.

 

Should I eat before surgery?

Yes you should eat a small meal before you arrive. We also recommend you bring snacks as you may be in the office for a few hours.

 

Will my activity be limited after surgery?

Yes, we recommend you limit your physical activity including heavy liftin immediately after surgery. If your job requires heavy lifting or bending over we are happy to provide a physicians note. The length of restriction will depend on your wound and will be discussed prior to your surgery.

 

Will I have pain after surgery?

Most people experience little pain following surgery which is commonly experience in the first 24 hours following the procedure. We recommend you take an extra strength Tylenol when you get home followed by icing the area around the wound. You will receive written instructions regarding further pain management prior to leaving our office.