Mohs surgery is a treatment for skin cancer that involves the surgical removal of the cancerous cells. The surgery basically involves removing thin-layers of cancerous skin in a progressive manner and is examined in a lab until only cancer free tissues are left on the skin. The goal of the surgeon is to remove as much as cancerous tumor as possible preserving the healthy tissues on the skin.
Mohs surgery is used for treating the most common skin cancers like basal cell carcinoma and squamous cell carcinoma, although the rate of effectiveness varies. It is also used for treating various kinds of melanoma. Therefore, it is generally used in cases where the cancer has a chance of recurrence or has recurred even after proper treatment. It is also used when the cancerous tumor is located in areas like the eyes, ears, nose, mouth, hands, feet and genitals or when the tumor is large and aggressive.
The surgery was first introduced by Dr. Frederic E.Mohs in 1938. However, the technique of the treatment has evolved from the earlier days and involves a team of doctors and surgeons to perform the surgery. It generally requires- a surgeon to remove the cancerous tumor, a pathologist who will analyze the cancerous tissues in a lab, a surgeon who will close or reconstruct the wound and aesthetics. Generally the surgeon doing the surgery also performs the role of a pathologist and dermatologists. The surgery is done on an outpatient basis with local anesthesia.
Mohs surgery can be performed by a dermatologist who is a surgeon or a general surgeon and is done in an outpatient or procedure room. As the surgery requires a whole day, the patient is asked to prepare for the surgery by- stopping any medications like blood-thinning medicines, taking the day off from your work, wearing comfortable clothing and brining some books or magazines to help you pass the time.
The surgery involves using anesthesia to numb the area where the procedure will be performed. Once the area has been numbed, the surgeon or a nurse takes a pen and marks the area where you had your biopsy for reference. After which the surgeon uses a scalpel to remove a portion of cancerous tissue. Some skin cancers have deeper roots that are not visible from the surface. Therefore, to know exactly the position of any existing cancerous tissues, the removed cancer cells are taken to a lab for analysis. In the lab the surgeon or pathologists dissects the tissue into smaller portions and examines them under a microscope. The surgeon keeps track of the area where the cancer cells were removed and makes a map on the surgical site. If after the lab analysis, more cancerous cells are found, then using the map he removes another layer of skin containing cancer and takes it for further analysis. This process continues until all the cancer tissues and cells are removed and your skin is left cancer-free. After which you and your surgeon will decide how to close the wounds. The doctor may let the wound heal on its own or use stitches to close the wounds. The wound may also be healed by shifting skin from an adjacent area (skin flap) to cover the wound or using skin graft technique from another part of the body to cover the wound. Your doctor may refer you to a reconstructive surgeon if further repair is needed.
People who are suffering from skin cancers like basal cell carcinoma and squamous cell carcinoma are eligible for the treatment. It is also used in cases where the cancer has recurred after previous treatment or you are suffering from melanoma.
People not suffering from any kinds of skin cancer or other type of cancer or uncomplicated non-melanoma are not eligible for the treatment.
There are certain risk factor associated with Mohs surgery like bleeding, pain or tenderness around the surgical site and infection. These side effects are common among various surgical procedures and need to be monitored. Additional side effects include temporary or permanent numbness surrounding the surgical area, if some nerve endings are cut, temporary or permanent weakness of the surgical area, if the cancerous tumor is large and muscle nerve is severed. There can also be itching or shooting pain in the surgical site and an ugly and bid scar (keloid) on the area. These are rare and uncommon side effects of the treatment and can be controlled and contained through proper medication.
The post-surgery measures for the treatment includes- not to touch the wounded area with your hands or poke it to see how your wound is healing up. Further poking may cause infection or lead to bleeding. If you are experiencing pain and difficulty while moving or doing any sort of physical activity, it is advised to take rests for a few weeks and then get back on your feet. Remember to follow-up with your doctor or a dermatologist for a change of your dressing and ensure proper healing. Ensure to have skin exams to spot reoccurrence of any cancer. In general cases, skin analysis should be done at least once or twice a year.
Although mohs surgery takes only a day to perform and does not any hospitalization, the post-recovery time can range from 1 to 2 months depending on where the surgery is performed.
The price for mohs surgery can start from Rs.50,000 and go up to Rs.2,00,000 depending on the type of skin cancer, the site of cancerous tumor, your doctor’s fee and the hospital you are having the surgery.
The advantage of mohs surgery is that the results of the procedure can be known immediately. Although the rate of cure for skin cancer is high for mohs surgery, there is always a chance of cancer reoccurring. Most people diagnosed with skin cancer may develop other kind of skin cancer within five years.
There are various other alternatives to mohs surgery for treating skin cancer that includes- radiation, topical chemotherapy, cryosurgery, electrodesiccation and curettage. The other method that has been developed recently and is used for treating non-melanoma skin cancer is SRT-100 which is a skin radiation therapy.