Mohs Surgery

What is Mohs Surgery?

Mohs surgery is an advanced technique where the physician serves as the surgeon, pathologist, and reconstructive surgeon. During the initial portion of the procedure, the surgeon removes a layer of skin around the visible portion of the tumor. Immediate microscopic examination of the tissue removed allows the surgeon to map out the skin cancer, beyond what is visible to the naked eye, and remove additional tissue from only the areas that are involved with the tumor. The removal process stops when there is no longer any evidence of cancer remaining in the surgical site.

The reported cure rates in the medical literature for the  Mohs technique are 95% to 99% cure rate for lesions treated depending on skin cancer subtype and whether the lesion is recurrent.  Our goal with Mohs is to only remove the tissue involved with the tumor to minimizes the postoperative defect and hopefully provide a better cosmetic result.

Dr. Russell Akin is a fellowship trained Mohs surgeon and the only one in the Permian Basin.

What to Expect

The Mohs surgery procedure is done under local anesthesia. Photographs are taken before, during and after surgery. The majority of your time will be spent waiting for the slide preparation and interpretation. Once the tissue has been surgically removed, the wound is dressed with a temporary bandage while the tissue is processed.  The number of times you return to the surgical suite for removal of tissue is determined by the results of microscopic examination of the tissue. The tumor may require only one stage for complete removal or multiple stages. The surgery is continued until the tumor is completely removed by the microscopic examination. The procedure may last from a couple of hours to several hours.

Skin Cancers treated with Mohs surgery

The most common skin cancers treated with Mohs surgery are Basal Cell Carcinoma and Squamous Cell Carcinoma.  At Midland Skin Cancer Center we also remove with Mohs surgery lentigo maligna (the most superficial form of melanoma) with MART 1 immunostains.  This is a advanced technique not offered by most Mohs surgery practices.  Immunostains allow us to remove the tumor and process the tissue with a stain that highlights the melanocytes making it easier to remove these skin cancers with more complete evaluation of the margin.  We also remove unusual skin cancers with Mohs surgery at Midland Skin Cancer Center.

Postoperative Care

Supplies needed for wound care:

  • Non-stick dressing (Telfa)
  • Paper tape
  • Petrolatum (Vaseline) ointment
  • Soap and water (any bath or hand soap)

Bandage Dressing:

  • Wash hands and remove original dressing in 24 hours. Gently clean wound with soap and water. Rinse with water and pat the wound dry with gauze or a dry cloth.
  • Apply a thin layer of Vaseline ointment with Q-tip.
  • Cut Telfa to fit over the wound. If the wound is large or draining, place gauze over the Telfa. Secure the dressing with paper tape.
  • Change dressing once daily. It is important that the wound stays moist with the ointment and that a scab does not form.

What to expect after surgery:

Pain management:

The surgical site may be sore for several days after surgery. You may take Tylenol (acetaminophen), as directed on the bottle, if needed for discomfort. Do not take aspirin, aspirin-containing pain medicines, ibuprofen (Advil, Motrin), or other NSAIDs (Alleve) since these may cause bleeding.

Bleeding:

Most bleeding can be stopped by applying firm constant pressure to the dressing with a dry, clean gauze to the surgical site for 30 minutes (NON-STOP). If the bleeding does not stop after applying pressure for 30 minutes, please call Dr. Akin. If you are unable to reach the doctor, go to the Emergency Room.

Appearance:

Swelling and redness may occur around the wound for several days. If surgery is done around the eyes such as the nose or on the forehead or scalp, the area around the eyes is often quite swollen and discolored for several days. The eyes may even be swollen shut which will affect the ability to work or drive. This may not peak until 48 hours after surgery. Drainage is to be expected in wounds that are not stitched and allowed to heal on their own. The drainage may be yellow-green and have a slight odor. It usually begins several days after surgery.

As the wound heals, you may feel skin tightening, itching of the scar or small sharp pains in the scar. These feelings are normal and will lessen as time passes. Massaging the scar (after stitches are removed- but wait 6 weeks) will often help flatten, soften and decrease itching of the scar. Scars are pink for several months after surgery and eventually turn white. The surrounding area may feel numb. This is usually temporary lasting 6 months. The deep stitches may feel like “lumps” under the skin which will also go away over the next several months.

Infections:

If the skin around the surgical site develops expanding redness, swelling, and pain and the wound begins to drain pus, you may have an infection. Please call the doctor.

Activity Restrictions:

If stitches were placed, please avoid heavy lifting and exercise till the stitches are removed.

Medications:

Please continue your prescription medicines as directed by your physician.

Showering:

You may get the area wet by showering or washing your face after 24 hours, but afterward, be sure to clean the wound as directed above. If stitches were placed, please no soaking wound in bathtub or swimming pool until stitches are removed.

Shaving

Directly avoid the area of sutures while shaving.