• Primary Closure: The skin around the wound is loosened then closed in a straight line using layers of deep and superficial sutures. The incision line will be longer than you may expect as the final length is usually three to four times as long as the diameter of the wound. • Flap: The skin adjacent to the wound is elevated and moved to cover the defect. Flaps are typically used for delicate or difficult areas, under tension, and to minimize distortion. • Skin graft: Skin from a different area of the body is used to cover the wound. This type of repair can take longer to heal but can provide excellent results. • Healing by granulation: The wound is left open and allowed to heal on its own. Certain areas heal very well by this manner though typically will take the longest to heal. How is Mohs Surgery Performed? Mohs surgery is a highly sophisticated procedure performed by a team of medical personnel that includes the surgeon, nurses, and technicians. It is an outpatient procedure performed under local anesthesia. Your provider performs Mohs on only one site per day. If you have more than one site for Mohs surgery, we will schedule separate appointments one week apart for each site to be removed. Your provider makes exceptions for patients who travel a great distance to come for the surgery. On the day of the surgery, the area of the biopsied skin cancer is identified together by you and your provider. After the region is adequately numbed, the visible cancer is scraped away using a curette to better delineate the cancer. A thin margin of tissue is then taken around and underneath with a scalpel that results in a disc shaped piece of skin being removed. The blood vessels are sealed
using an electrocautery and a pressure dressing is applied. The removed tissue is mapped, oriented and marked with colored dyes for orientation and submitted to the technicians to process. The specimen is frozen, cut, stained and placed on a glass slide. Your provider then carefully examines the mapped slides under the microscope to look for any residual cancer on the margins. This allows your provider to pinpoint the precise location of any cancerous roots that remain so extraction can be very precise. Your provider thoroughly evaluates 100% of the margin including all of the edges and the base of the tissue taken. Unlike excisions or other types of pathology tests where only 1-2% of the outer margin is visualized (bread loafing technique), Mohs processing is very unique in that 100% of the tissue margin is visualized. Combining that with the added precision of the surgeon reading the pathology slides gives Mohs surgery the highest cure rate. Each removal and processing of tissue called a “stage” takes approximately 1 hour. If cancer is visualized under the microscope, the surgeon marks that precise area on the map. The patient is brought back into the procedure room and additional tissue is precisely removed from the positive region only and submitted to the Mohs lab for processing. This process is repeated until the margins are clear of cancer. On the average, it takes one to three “stages” to clear the cancer. Benefits of Mohs Surgery Mohs surgery offers the absolute highest chance for cure of most skin cancers compared to all other therapies. The cure rates for other common techniques used to treat skin cancer can be as low as 50-70% for previously unsuccessfully treated skin cancers. Using Mohs techniques with the surgeon as the pathologist,
precisely locating tumor roots and excavating those roots leads to cure rates as high as 97-99%, even when other forms of treatment have been unsuccessful. Besides the highest cure rate, the precision of tissue evaluation allows the smallest margin possible to be taken, which results in smaller surgery scars, because an unnecessary margin of healthy tissue is not taken. Those who prefer to know definitively that the cancer is completely removed before the tissue is repaired (no guessing), prefer Mohs because when tissue is sent to a pathology lab it generally takes 5-7 days after surgery to find out if the estimated margins were indeed adequate. Prepare for the Day of Mohs Surgery
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