Mohs Microsurgery

What is Mohs surgery?

Mohs micrographic surgery is a highly specialized surgical treatment for skin cancer that provides the highest cure rate compared to traditional techniques.

The original procedure of Mohs micrographic surgery was developed by Dr. F. Mohs at the University of Wisconsin. The Mohs technique has been refined, although in its basic concept it is still based on three fundamental steps.

What is Mohs surgery?

1. Removal of tumor tissue: First the anesthesia is anesthetized, the procedure is not started until insensibility is assured in the entire area. Once the anesthesia is completed, the layer of skin affected by the tumor is removed.

2. Sophisticated preparation of small portions of excised tissue for microscopic examination and determination of whether or not the tumor has been completely removed.

Hemostasis is performed to prevent bleeding and the wound is provisionally cured pending the outcome of the laboratory. During the waiting time of the microscopic analysis the patient may be accompanied, read a magazine or watch television. The approximate duration of this phase is about 30-45 minutes.

Once the lesion has been removed, 100% of the margin is analyzed. For this reason, small portions of tissue must be prepared so that it is possible to observe them under a microscope.

The cuts of the portions are made in freezing in a cryostat duly marked for identification under the microscope.

3. If cancer cells are detected, repeat all the above procedure, but only in the affected area, until total cure is achieved.

Once observed in the microscope they are identified in a graph to guide the existence of malignant cells in case of finding them and to be able to extirpate the tissue where it is required. The procedure is repeated until the entire tumor is removed.

The defect resulting from the removal is "repaired" in the most aesthetic possible way, depending on its magnitude, location, skin type, etc.. The final aspect is achieved a few months after the points are removed.

Under normal conditions, the average number of stages in Mohs surgery is one to three (usually 2-4 hours until complete healing), although it depends on the particularities of each tumor, whether it has previously been treated and its location.

Where is Mohs surgery performed?

The procedure is slow, sophisticated and requires very specialized personnel, so there are very few centers in Spain equipped to offer Mohs surgery.

What is done with the wound left?

Once the tumor is completely removed, the best solution to close the wound created by the Mohs surgery is decided.

Sometimes it is preferred that it close on its own, requiring daily cures for approximately 3-4 weeks.

Other systems consist of closing with sutures directly or through the use of flaps, grafts or cosmetic surgery techniques. The choice depends on the size and location, in any case the patient will be carefully informed about the care required for each particular case.

What is the normal posterior evolution after Mohs surgery?

Most patients notice a tightness in the wound that diminishes over time.

A certain degree of itching following wound healing is also normal and benefits from any moisturizer applied on top (simple vaseline is sufficient).

Most tumors affect nerve superficial branches, so it may take a year until the normal sensation returns to the area. Until then, the sensations of tingling with the cork can coexist in the area, or alternating both.

The tissue surrounding the wound contains much more blood supply than normal for the healing process. This causes the skin to look more pink and more sensitive to changes in temperature. Both the sensitivity and the redness disappear with the passage of time.

It must be taken into account that the definitive aspect of a wound must be assessed at the time of the intervention.