Mohs micrographic surgery (MMS), also known as microscopically controlled surgery, was developed by Dr. Frederic Mohs in the 1940’s. It is a common procedure performed by board-certified dermatologists (called Mohs surgeons in honor of Dr. Mohs) used to treat certain skin cancers (see below) with microscopic precision. This method of treating skin cancers allows accurate surgical removal of the skin cancer by immediate microscopic examination of the tissue to identify any remaining cancerous tissue and allows preservation of healthy surrounding tissue.
Mohs surgery is often used in the following scenarios:
Mohs surgery is performed on an outpatient basis and requires a local anesthetic. In addition to having a higher success rate, Mohs is also recognized for its precision, making it the most aesthetic choice for skin cancer treatment.
Recovery time depends on the size of the skin cancer removed, anatomic location, and method of wound closure. While some wounds can heal by themselves, others may require sutures, tissue rearrangement, a skin graft, or in some cases, reconstructive surgery.
If any discomfort should occur following this treatment, it is usually mild and can be treated with extra-strength Tylenol. While minimal bleeding is common, you should seek immediate medical attention if you experience persistent, excessive bleeding.
If you have Mohs surgery, you’ll see a board-certified dermatologist who has been extensively trained in the Mohs micrographic technique and has also has sub-specialty board-certification in Micrographic Dermatologic Surgery (MDS).
During MMS, most patients remain awake and alert. This means MMS can safely be performed in a medical office or surgical suite. Only if extensive surgery is necessary would you be admitted to a hospital.
On the day of the surgery, your surgeon will first examine the area to be treated. You’ll then be prepped for surgery. This includes giving you an injection of anesthetic. This injection only numbs the area that will be operated on, so you’ll be awake during the surgery.
Once the anesthetic takes effect, the surgery can begin. The surgeon starts by first cutting out the visible skin cancer. Next, the surgeon removes a thin layer of surrounding skin. You’re then bandaged so that you can wait comfortably.
While you wait, the MMS surgeon looks at the removed skin under a microscope. The surgeon is looking for cancer cells. If cancer cells are found, you’ll need another layer of skin removed.
This process of removing a thin layer of skin and looking at it under a microscope continues until the surgeon no longer sees cancer cells.
Once cancer cells are no longer seen, your surgeon will decide whether to treat your wound. Some wounds heal nicely without stitches. Others need stitches. To minimize the scar and help the area heal, some patients require a skin graft or other type of surgery.
If you need wound treatment, your MMS surgeon may treat the wound that same day. Some patients with a large wound are referred to another surgeon for wound treatment.
No matter what type of skin cancer you have, Mohs micrographic surgery is only recommended for certain patients who have skin cancers amenable to this type of surgery, are good surgical candidates, able to tolerate being awake and comfortable for outpatient surgery that can take hours to complete.
Having any type of surgery can be scary. If your dermatologist recommends Mohs micrographic surgery, you can take comfort in knowing these few facts: Mohs micrographic surgery has the highest cure rate, and your Mohs micrographic surgeon will remove the least amount of skin needed to treat the cancer.
Use this infographic to learn what to expect during Mohs surgery.
Your Mohs surgeon examines the area to be treated and preps you for surgery, including an injection of local anesthetic that numbs only the operative area. You remain awake and alert throughout.
Once the anesthetic takes effect, the surgeon cuts out the visible skin cancer and removes a thin layer of surrounding skin. You’re bandaged so you can wait comfortably.
While you wait, the Mohs surgeon examines the removed skin under a microscope, looking for cancer cells. If cancer cells are found, another thin layer of skin is removed and the process repeats until no cancer cells remain.
Once the area is cancer-free, your surgeon decides how to close the wound. Some wounds heal nicely without sutures; others may need sutures, tissue rearrangement, and some may require a skin graft, or in some cases, reconstructive surgery.
Serving Brentwood, TN and the surrounding greater Nashville metropolitan area, Dr. John Binhlam provides expert medical, surgical, and cosmetic dermatology care tailored to your individual needs. Our team is committed to helping you achieve healthier skin with personalized treatment and compassionate care.
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