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  What is Mohs Micrographic Surgery?
How is it performed?
What types of skin cancer are treated with Mohs Surgery?
How long will the surgery take?
How do I prepare for surgery?
Will I need plastic surgery after the skin cancer is removed?
What is the recovery period for Mohs Surgery?
Are there any follow up visits needed?
What are the chances that the skin cancer will return?
Will my insurance cover the cost of the surgery?
Mohs Micrographic Surgery is a specialized way of removing skin cancer. This technique has two main advantages over other treatment options. First, it allows the surgeon to remove only the smallest amount of tissue necessary. This is called "tissue conservation" and is especially important in areas where there's not much tissue to spare, such as around the eye, nose, ear, or lips. Second, this technique yields the highest cure rates (around 96-99%) of all the treatment options for skin cancer.
 Once the skin cancer site is confirmed and numbed using local anesthetic, a thin layer of tissue is removed around the biopsy site/skin cancer. The tissue is oriented using special inks, and a corresponding map is drawn of the tissue. The tissue is processed on site, and the surgeon examines it under the microscope. If any roots of skin cancer are identified during the microscopic examination, they are noted on the map.
The patient is then brought back in the surgery room, and additional tissue is removed only in the areas where cancer cells remain. The map is used to determine exactly where to take more tissue. The process continues until no further skin cancer is identified under the microscope.
Once all the cancer cells have been removed, the doctor and patient review the options for reconstruction. These options may include simple stitches (or a "primary closure"), a skin flap, a skin graft, or letting the area heal on its own (also known as "secondary intention").
There are certain types of skin cancer that are best treated with Mohs surgery. These include non-melanoma skin cancers on the head or neck, those with aggressive features noted upon biopsy, large tumors, and those that have recurred after previous treatment. Patients who are immunocompromised or have had many previous skin cancers are also ideal candidates because their skin cancers have a greater chance of being aggressive or extensive.
You should plan on being in the office for the better part of the day. Each "layer" of tissue can take 30-60 minutes on average to be processed and examined. While you are waiting, you can relax in our Mohs waiting area. Feel free to bring a visitor to keep you company while you wait.
You are able to eat breakfast and lunch as well as snacks on the day of surgery unless otherwise instructed by the doctor. Please take all of your normal medications unless the doctor has advised you otherwise.
Mohs surgeons are extensively trained in skin cancer reconstruction. In some circumstances, Mohs Surgery may need to be coordinated with another surgical specialist, such as a plastic surgeon. Dr. Spenceri will review the anticipated reconstruction options with you both at the time of consultation as well as on the day of surgery. In some instances, such as with very large tumors, Dr. Spenceri will coordinate the Mohs Surgery with reconstruction by a plastic surgeon or head and neck specialist.
Most stitches will need to be removed between 6 to 14 days. You should try to "take it easy" during this immediate post-operative period as far as exercise and strenuous activity are concerned. You can usually resume your normal bathing routine within 48 hours.
Additional follow-up visits are determined on an individual basis. Once the wound is fully healed, you will be able to follow up with your dermatologist or referring provider for routine skin checks.
There is a 1-4 % chance that a basal cell carcinoma or squamous cell carcinoma, treated with Mohs Surgery, will recur. These are the lowest recurrence rates of any of the treatment options. Some skin cancers are inherently more aggressive and have a greater risk of recurring around the scar tissue or possibly spreading to other parts of the body. Dr. Spenceri will review any of these concerning features with you during your consultation and surgery date.
Because Mohs Surgery is a proven, preferred way of treating many skin cancers, essentially all insurance companies will cover the cost of the surgery and the subsequent reconstruction. Of course, any necessary co-payments, deductibles, or coinsurance are considered by the insurance carriers to be the patient's responsibility. Feel free to discuss any insurance or billing question with our reception or billing staff.
For more information on Mohs micrographic surgery visit www.mohscollege.org.
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