Skin Cancer Patients Find Options in Mohs Surgery

Today, skin cancer is the most common cancer diagnosed in patients across the country. As you may expect, there are many different treatments for skin cancer. However, Mohs micrographic surgery (Mohs surgery) is an outpatient procedure that has the highest cure rate available for the most common types of non-melanoma skin cancer: basal cell carcinoma and squamous cell carcinoma. And Mohs surgery is now offered to patients in northwest Ohio.

Matthew Molenda, MD, FADD, is a dermatologist/dermatologic surgeon with ProMedica Physicians who commonly performs the Mohs surgery procedure. According to Dr. Molenda, the procedure has proven to be the single most effective technique for removing and treating non-melanoma skin cancers, with a cure rate exceeding 95% in most patients who are in otherwise good health. Dr. Molenda offers his viewpoint on this new cancer procedure.

What is Moh’s surgery?       

Mohs surgery is a tissue-sparing procedure performed under local anesthesia to remove skin cancer one layer at a time. A tissue-sparing procedure simply means that normal, healthy skin and support structures are conserved when compared to standard removal procedures, resulting in better functional and cosmetic outcomes.

Once a skin cancer layer is removed, a customized tissue map is created, and the tissue is processed and stained in a specialized way that allows your surgeon to examine the complete margin under the microscope. If cancer cells are still visible under the microscope, then your surgeon will remove another layer of tissue exactly where it is necessary, based on the customized tissue map.

Are any additional procedures or surgeries required?

After the skin margin has been cleared with Mohs surgery, the patient then has reconstructive surgery, usually the same day and under the local anesthesia that is already in effect. A typical Mohs surgery and reconstruction can take three to five hours, some of which is wait time for tissue processing and microscopic margin examination. During this wait time, patients are able to walk around the office, and many bring reading materials to keep themselves occupied.

What are the benefits of Mohs surgery as an outpatient service?

Since tissue removal, processing, and microscopic examination happen in the outpatient office setting, patients no longer have to wait several days to find out if their skin cancer has been completely removed. When there are no more cancer cells detected under the microscope the Mohs surgery is complete.

In addition to Mohs surgery, there are other effective treatments for non-melanoma skin cancers that have excellent cure rates of around 85-90% for primary skin cancers.  However, they can result in larger wounds or scars, having less favorable outcomes in sensitive areas.

What is the recovery time for a Mohs surgery patient?

Recovery for the procedure is generally well tolerated, with most discomfort easily controlled with ice packs and acetaminophen (Tylenol). Patients should plan on taking one to two days off work, and should refrain from strenuous exercise or high stress situations in order to minimize rises in blood pressure.

How can patients prepare for their Mohs surgery appointment?

I offer two checklists for my Mohs surgery patients to consider. One week before the procedure patients should:

  1. Gather a list of all medications and supplements for the appointment. Be sure to include doses and last dose taken.
  2. Stop elective blood thinners, such as aspirin and fish oil at least seven days prior. If your doctor told you to take aspirin because of a history of heart disease or stroke, do not stop your aspirin. Do not stop prescription blood thinners. If you are on Coumadin, please know your last INR number and when it was last checked.
  3. Arrange for a driver if your procedure will be above or near your eye (forehead, bridge of nose, eyelids, frontal scalp, upper cheeks). A dressing with gauze may obstruct your vision, so a driver is necessary.
  4. If you need antibiotics before dental procedures because of artificial joints in the past two years, history of heart murmur or other reasons: please notify the office of what you normally take and your known drug allergies. Please indicate a pharmacy phone number we can call in a prescription.

Your day of surgery checklist should include:

  1. Eating a healthy breakfast and taking your regular medications.
  2. Bringing a list of medications with dosages.
  3. Bringing your driver if your operation is near your eye.
  4. Bringing reading material or something to keep you occupied during the expected wait time while your tissue is being processed and checked.
  5. Packing snacks or a lunch. you are free to eat and drink while you wait. Diabetics should plan accordingly.

Who can opt for the Mohs surgery procedure?

Patients who are good candidates for Mohs surgery will have non-melanoma cancers that:

•           Are located in a visible, sensitive and/or tight area of the body, including the face, head, neck, genitals, hands, feet, and shins.

•           Are aggressively growing or evolving rapidly.

•           Have a high risk of spreading to other parts of your body.

•           Are greater than 2 cm in diameter where standard surgical margins would make closure difficult.

To receive more information or to find out if Mohs surgery is an appropriate treatment option for you, call Dr. Molenda’s office at 419-291-7007.