without aggressive features in areas that do not require tissue sparing may also be treated by standard excision (cutting the tumor out and immediately sewing it up, without checking to see if it is clear first).
Mohs surgery involves a same-day procedure where an initial "layer" is taken (the clinical tumor) and examined under the microscope for any involvement of the edges while the patient waits. The tissue is mapped in such a way so that if there is tumor at any one edge, the surgeon knows exactly which edge this is and can go back to take another small piece of skin from this edge only (instead of another whole circle around the defect, leaving a larger defect than necessary). Repair/Reconstruction Once the Mohs surgery is complete, you will have a wound or defect where the cancer was located. This wound can vary in size but will always be larger than what was seen initially with the naked eye. The second part of the procedure is repairing this wound. Although Mohs surgery allows for maximal tissue preservation, all surgery results in a scar. Your provider is an experienced reconstructive surgeon and will review the options and recommend the repair that would likely result in the best cosmetic and functional outcome. Common Types of Repairs: • 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
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