What Is Mohs Surgery For Basal Cell Carcinoma

Basal Cell Carcinoma & Mohs Surgery: What To Expect & How To Prepare

I decided to log my journey with Basal Cell Carcinoma and Mohs surgery recovery because there are mainly technical sites that arent comprehensive with information on what to expect. Knowledge gives me comfort. My posts give explicit details and surgical photos. If youre not a detailed person or if you get an icky feeling seeing surgical photos, dont read any further. If youre like me and want ALL the details, this blog post is for you.

I hope knowledge gives you comfort, too. One blogger getting Mohs surgery had not seen pics of the actual surgery and was so shocked afterwards that she bawled all the way homewhile driving. I liked knowing what I was walking into. If I had to bawl out crying, I wanted to do so in the safety of my home, not in my car while driving.

Side note: I am an anti-selfie person. I never take selfies. But to document this journey, I took a lot. And I think it helps to take pics along the way to better recognize the progress.

What To Expect From Your Mohs Surgery

Mohs Surgery: What to Expect on the Day of Surgery Before the Surgery. Since the surgery is performed under local anesthesia only, you wont have to make too many During the Surgery. Mohs surgery is performed in one day as an outpatient or ambulatory procedure, but takes place in After the Surgery. Your surgeon will determine the best method for reconstruction once More

What Happens During Mohs Surgery

The procedure is done in stages, all in one visit, while the patient waits between each stage. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. The doctor repeats this process until no cancer cells remain.

Step 1: Examination and prep

Depending on the location of your skin cancer, you may be able to wear your street clothes, or you may need to put on a hospital gown. The Mohs surgeon examines the spot where you had your biopsy and may mark it with a pen for reference. The doctor positions you for best access, which may mean sitting up or lying down. A surgical drape is placed over the area. If your skin cancer is on your face, that may mean you cant see whats happening, but the doctor talks you through it. The surgeon then injects a local anesthesia, which numbs the area completely. You stay awake throughout the procedure.

Step 2: Top layer removal

Using a scalpel, the surgeon removes a thin layer of visible cancerous tissue. Some skin cancers may be the tip of the iceberg, meaning they have roots or extensions that arent visible from the surface. The lab analysis, which comes next, will determine that. Your wound is bandaged temporarily and you can relax while the lab work begins.

Step 3: Lab analysis

Step 4: Microscopic examination

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Prepare For The Possibility Of Grafts

I have had several squamous cell cancers on my face, including 3 around and on my nose. You cant see scarring. The only time I had pain was when I had a large one removed from my forehead and down around my eye and nose with a skin graft on my nose. If I get anymore, I certainly wont hesitate to have them removed. So you can do this! Bonnie

I had Mohs about the size of a dime At the end of my nose. Didnt feel a thing. Took graft from behind ear to fill hole. Only took Tylenol for pain. Bolster bandage the first week to hold graft in place was just annoying and thought I might pull off in sleep, but I didnt. You will be ok. If you are anxious tell them, usually the assistants will put you at ease. Good Luck! Jeanne

I had basal on my nose. I can tell you it by far was the most painful surgery of all skin cancers that I have had. The nose is a VERY sensitive area and the anesthesia wears off very quickly. Had to be injected too many times to count. My cancer was there since childhood . The result: a dime-sized hole on top of my nose and the entire inside of nostril was filled with cancer. Had skin grafts and left with part of my nostril missing. No one knows unless I point it out. Doctors are amazing and the procedures they can do are as well. I hope I dont scare anyone, just want to share that if I had known so much earlier this wouldnt have been as invasive. Had it been squamous I dont think I would be here. Stay on top of your skin! Vickie

Skin Grafting And Reconstructive Surgery

After surgery to remove a large basal or squamous cell skin cancer, it may not be possible to stretch the nearby skin enough to stitch the edges of the wound together. In these cases, healthy skin can be taken from another part of the body and grafted over the wound to help it heal and to restore the appearance of the affected area. Other reconstructive surgical procedures, such as moving ‘flaps’ of nearby skin over the wound, can also be helpful in some cases.

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How Do You Prepare For Mohs Surgery

As with any surgery, discuss your allergies, medications, and supplements with your doctor. If you drink one or more alcoholic beverages daily, ask if you should stop your intake prior to surgery. Also let your doctor know if you smoke cigarettes or use any other tobacco or nicotine product.

Come clothed for the procedure in comfortable, loose-fitting clothing.

If youre having the surgery done near your eye and wear contact lenses, ask your doctor if you should remove them for the day. If you wear dentures and need surgery near your mouth, you may need to remove your dentures during the procedure.

Youll be awake for the entire surgery. Its hard to predict how long Mohs surgery will last. Three or four hours or longer is common. The procedure may comprise several waiting periods while the layers of removed tissue are analyzed. Youll be able to sit up and relax during these wait times. You may wish to bring something to occupy yourself, such as a book, crossword puzzles, or knitting.

Even though the time frame for Mohs surgery is hard to predict, make plans ahead of time to have someone waiting who can take you home once the surgery ends. Dont schedule anything else for the day other than rest.

Since you will not be under general anesthesia, its usually recommended that you eat breakfast before arriving.

Know That Surgery Sites Heal In Time

Had basal cell on the side of my nose going toward the corner of my eye. Couldnt see anything on the skin, but thanks to the keen eye of my derm she saw it, and did a biopsy, and sent me to a Mohs specialist at UAB. He removed it along with surrounding tissue, sutured, sent me on my way looking, well, terrible! Within 1 year, the scare is completely gone & cant tell anything was done. Thankful for those yearly scans. Debbie

I had Mohs done on a very small spot on side of nose right by eye. They had to put me to sleep and did a flap on forehead. Also had Mohs on lip. It went about 2 inches outside of mouth and about an inch in mouth. Great results. Almost unnoticeable. Joy

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Basal Cell Carcinoma On My Neck

This post is about my experience with basal cell carcinoma skin cancer and how I had it removed with Mohs surgery. Oh and its also about how I became depressed. I want to share my story in case you know anyone who has one of the better skin cancers, like basal cell, or you have it yourself.

It is ok to be scared. Even though a lot of people will not give it a second thought, it is ok to feel uneasy about it.

WARNING: I share photos with my stitches. If you are squeamish, you may want to skip it. I mean, its not all that grotesque but want to give fair warning.

I had two spots that I wanted my doctor to check out, especially because my dad had been dealing with his own skin cancer issues for the last few years. I take after his light complexion so I thought it couldnt hurt to get a doctors opinion.

The two main concerns for me were a little red mark, that had been on my neck for about two months and a mole close to my ripple that had a white ring around it (yes, I said ripple.

I dont want any McPerversons coming to my site after searching for the female body part and I think you can figure out which one I mean).

My general practitioner didnt think anything was wrong with those two things but she didnt like the way a mole looked on my back and referred me to a dermatologist.

So began the journey of having moles biopsied. Over my first few visits, the dermatologist evaluated my moles and skin and weve set about prioritizing what we need to focus on first.

After Skin Cancer Surgery Careful Reconstruction Around Eyes And Nose

Elizabeth Ann Badgett

For six months, Elizabeth Ann Badgett, of Clayton, NC, watched a painless, scaly spot appear and disappear on her nose. Each time the spot returned it was larger until it reached the corner of her left eye. Her primary care doctor referred her to a dermatologist, who diagnosed the spot as skin cancer.

There are three predominant types of skin cancer: basal cell skin carcinoma, which is the most common, squamous cell carcinoma and melanoma. Badgett, 62, was diagnosed with basal cell skin cancer. It had to be removed.

Duke dermatologic surgeon Dr. Jonathan Cook, MD, performed Mohs surgery, the most effective way to remove basal cell and squamous cell skin cancer. In the process, he had to remove a large area of tissue on her lower eyelid, cheek, and nose that extended to layers deep against the bones. Badgett needed reconstructive surgery to improve the function and appearance of her eye and face.

Skin Cancer Treatment at Duke

Also Check: Is Basal Cell Carcinoma Serious

Reconstruction After Mohs Surgery

In the majority of cases, reconstructive surgery will be performed by yourMohs surgeon immediately after the skin cancer has been removed. Largedefects in cosmetically and functionally sensitive structures such as thenose or the areas around the eyes or ears may require a skin graft or localflap to restore the features of the face. Other Mohs procedures may notrequire reconstructive surgery at all. In advanced cases requiring largerreconstructions that are better performed in the operating room undersedation or general anesthesia, your Mohs surgeon may coordinate yourreconstructive work with a highly qualified Johns Hopkins plastics, facialplastics or oculoplastic surgeon. A consultation with your Mohs surgeonwill help determine what type of reconstructive surgery you will need.

Reconstruction After Mohs Surgery | Amber’s Story

What Does Basal Cell Carcinoma Look Like

When the DNA in the basal cells is damaged and a basal cell carcinoma develops, it will appear as a change in the skin, such as a growth or sore that wont heal. The lesion will have one of the following characteristics. It will look like

• A pearly white, skin-colored, or pink bump on the skin. It will be translucent, meaning you can see through it slightly, and you can often see blood vessels in it.
• A brown, black, or blue lesion or a lesion with dark spots. It will have a slightly raised, translucent border.
• A flat, scaly, reddish patch of skin with a raised edge. These will occur more commonly on the back or chest.
• A white, waxy, scar-like lesion without a clearly defined border. This morpheaform basal cell carcinoma is the least common.

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Mohs Surgery: Still The Gold Standard Sometimes Too Much Of A Good Thing

For years, Mohs micrographic surgery , more concisely known as Mohs surgery, has worn the unofficial mantle of gold standard for the treatment of the keratinocyte cancers, basal cell and cutaneous squamous cell carcinoma . In this issue, Mark Teich, The Skin Cancer Foundations scientific director, interviews Mohs expert C. William Hanke, MD, discussing what makes Mohs surgery the optimal treatment for many skin cancer patients and how it has evolved and improved over the years. Dr. Hanke also sounds a note of caution about how Mohs can be overused, entailing greater costs in time and resources for simpler cases that dont require it. For those not familiar with the Mohs technique, Dr. Hanke explains the basics, below.

Basics of Mohs Surgery

Mohs surgery gives you the highest cure rate and lowest recurrence rate of any skin cancer treatment, while preserving the maximum amount of normal tissue. In many cases it allows for less complex reconstructions and provides superior cosmesis.

Why such a difference in cure rates? The bottom line is, Mohs surgeons can evaluate 100 percent of the surgical margin compared with only about 1 percent using standard surgical excision. So, they are assured of locating nearly all residual cancer cells with Mohs, whereas standard excision amounts to an educated guessing game.

How Does Mohs Micrographic Surgery Work

The procedure is done in stages. After the affected area has been numbed with local anesthesia, the doctor uses a scalpel to excise the cancer in a disklike shape, says Dr. Leffell. When using the standard technique of simple excision, the surgeon must remove the tumor and cut a wide margin around it to ensure that she is removing as many of the abnormal cells as possible.

But with Mohs surgery, the doctor can start with a narrower excision and use a scalpel to remove just what is visible and can then later remove more if necessary.

The specimen is then brought to a laboratory that is a part of the Mohs unit. The specimen is divided into pieces and carefully mapped using different colors of ink. The tissue pieces are then processed in the lab and studied under the microscope by the Mohs surgeon, who can check the margins around the edges and underneath the tumor. Then the surgeon returns to the patient and removes another layer of cancerous tissue, if needed. In about 50 percent of cases, only one layer is needed to clear the cancer.

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Limitations Of Mohs Surgery

Mohs surgery is most successful in treating certain cutaneous neoplasms, and it can be used alone or in a multidisciplinary approach to achieve the highest possible cure rate for a variety of difficult-to-treat tumors. However, limitations of Mohs surgery may include the following:

• Noncontiguous tumors and/or disconnected foci in tumors may result in recurrence.

• Adjunctive therapy may be necessary to ensure cure.

• The extent of the tumor may be too great to be amenable to surgery.

Mohs surgery is indicated for the treatment of skin tumors that primarily spread by direct extension . This procedure would not be appropriate for tumors that have satellitosis, a multicentric origin, or skip areas. However, routine surgical excision of such tumors also fails, often at the expense of excessive tissue sacrifice.

Mohs surgery may also be limited by the extent of the tumor. This procedure is indicated for special situations, such as tumors that are deeply penetrating or that have perineural invasion. If the tumor is so deeply invasive that it involves bone and/or vital structures, a multidisciplinary approach is indicated. For example, tumors that invade bone may need to be cleared peripherally using Mohs surgery an additional specialist, such as an otolaryngologist and/or head and neck surgeon, may be consulted to treat the deep component of the tumor.

What Are Possible Complications Of Mohs

As with any surgery or procedure, Mohs is associated with possible risks and complications. While it is overall a very safe and effective surgical treatment, there are some possible uncommon complications. Since a scar forms anytime you cut the skin, most patients understand and can expect some type of a scar after skin-cancer removal.

Possible risks and complications of MMS are no different from those in conventional surgical procedures and include bleeding, bruising, wound infection, pain, unsightly scar, keloid , cosmetic disfigurement, skin discoloration, nerve damage, allergic reactions, pain, reaction to local anesthesia, wound opening and splitting or retained stitches, cancer recurrence, need for further surgery or treatment including radiation or plastic surgery, and very rarely death.

Minor, serious, or life-threatening side effects can occur with the use of anesthetics or with medications given before, after, or during surgery. Nerves controlling muscle movement, sensation, or other functions may be damaged. This nerve damage may be permanent. Overall, most patients tolerate the surgery very well without any complications.

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Surgery For Basal And Squamous Cell Skin Cancers

Surgery is a common treatment for basal cell and squamous cell skin cancers. Different surgical techniques can be used. The options depend on the type of skin cancer, how large the cancer is, where it is on the body, and other factors. Most often the surgery can be done in a doctors office or hospital clinic using a local anesthetic . For skin cancers with a high risk of spreading, surgery sometimes will be followed by other treatments, such as radiation or chemotherapy.