Mohs Surgery
Mohs Surgery is used to treat skin cancer. Mohs Micrographic Surgery was developed by Dr. Frederic Mohs, a doctor at the University of Wisconsin Hospitals and Clinics. It was first used to treat skin cancers in 1936. Since that time, it has been used to treat thousands of skin cancer patients. Today, we try to achieve the highest cure rates that we can for all skin cancers.
What is skin cancer?
Skin cancer is the uncontrolled growth of cells in the skin. Skin cancers are the most common of all cancers in the United States today. If found and treated early, most are curable. Skin cancers can be put into these groups.
Basal cell carcinoma is the most common form of skin cancer. It appears as a pearly, slowly enlarging growth on sun-exposed skin. With time, the area may form an open sore and may bleed. This form of cancer will slowly invade nearby skin or organs. Except in rare cases, it does not break off and spread to other parts of the body.
Squamous cell carcinoma is less common than basal cell. It often appears as a scaly growth, most often on sun-exposed skin. These cancers may also appear in scars, irritated skin, and areas such as the lips of chronic smokers. This form of cancer can sometimes break off and spread to other areas of the body (invasive).
Squamous cell carcinoma, in situ is confined to the top layer of the skin. This type of cancer may spread widely across the skin surface, but does not spread to other areas of the body. If left untreated, it may progress to become an invasive squamous cell cancer.
Melanoma is often found in or near moles. It may be highly dangerous if it spreads. If this form of cancer is found and removed very early, the cure rate is high.
Melanoma in situ is confined to the top layer of the skin. It may spread widely across the skin surface, but it does not spread to other parts of the body. If left untreated, it may progress to become an invasive melanoma.
What causes skin cancer?
The most common cause of skin cancer is damage to the skin from sun. This damage begins at a young age. It is most severe in those with fair skin, blue or hazel eyes, red hair, and freckles. Other less common causes are X-ray treatment, contact with arsenic, or chronic sores.
How is skin cancer detected?
Skin cancers can be diagnosed by doctors trained in skin cancer care. Samples or biopsies of growths are used to confirm the diagnosis.
How is skin cancer treated?
Skin cancers may be treated with Mohs Surgery, surgical removal, burning and scraping, X-ray treatment, freezing, chemicals, medicines (Efudex, Carac, etc), or lasers. The method of treatment depends on the kind, location, and size of the cancer, history of treatments, and age of the patient. In our clinic, most patients with skin cancer are treated with Mohs Surgery, because of its high success rate.
What is Mohs Surgery?
Mohs Surgery is a method of treating skin cancers in which the tumor is removed by surgery. All edges of the tissue are looked at under a microscope to assure that all of the cancer is removed.
Mohs Surgery requires very special clinic and lab skills. The bottom of each specimen is looked at with a microscope. If there are “roots” to the cancer, these “roots” are mapped out, and more layers of skin are removed until a tumor-free level is reached.
What are the advantages of Mohs Surgery?
The greatest advantage is that Mohs Surgery provides the highest cure rate for most skin cancers, yet it preserves as much normal tissue as possible. Since local anesthetics are used, the risk of surgery is very low. It rarely requires a hospital stay and is most often finished within one day.
What are the disadvantages of Mohs Surgery?
Mohs Surgery and other skin surgery are done using local anesthesia. Although the injections may be felt, it provides a very safe method of “numbing” the skin. When viewed under the microscope, if “roots” are seen at the edge of the tissue, more numbing injections and tissue removal may be needed to make sure that all the cancer is removed. Waiting for these test results can be hard. You may wish to leave the clinic while the lab work is being done and call or return for the results at a later time. Please check with your nurse about whether you may leave and, if so, what time you should return.
As with any skin surgery, there is always the risk of scarring. Measures to reduce scarring will be used; but, in certain cases, we may ask you to see a plastic surgeon (see page 6).
Can there be problems with Mohs Surgery or other skin surgery?
Problems can occur with Mohs Surgery as with any other method of treatment. These may include bleeding, nerve damage, scars, disfigurement, reactions to medicine, infection, return of the skin cancer, and other unforeseen events. These are very rare in the treatment of common, simple skin cancers. Your doctor may advise other treatment (or no treatment) if he feels that the risks are too high. Not treating a skin cancer results in the further growth of the cancer.
Is there a chance that the cancer will recur?
As with any other treatment of skin cancer, Mohs Surgery cannot guarantee a cure. But, since the microscope is used to trace out all “root-like” growths of a skin cancer, Mohs Surgery has the highest cure rate for most forms of skin cancer. It is often the best treatment when other forms of treatment have failed.
Should I think about other forms of treatment?
There are other methods for treating skin cancers. These include standard surgery, radiation, freezing (cryosurgery), burning and scraping (electrodesiccation and curettage), laser treatment, topical medicine, and other less common methods. Each method of treatment has advantages and disadvantages.
Keep in mind, you should feel good about the method of treatment proposed for you before it begins. If you wish to have a second opinion or time to think about other forms of treatments, you should take the time to do so.
How do I prepare for my clinic visit?
Treatment is often started at the time of your first visit. This is done in order to reduce the number of return visits for you. If you prefer to have treatment on a different date, this may also be done. If you have a very large or difficult tumor, or have other major health care problems, we may schedule your treatment at a later time. If you have other skin lesions you want checked, these may be looked at, but if treatment is needed, it may be done later in order to best serve all of our patients scheduled for that day.
Use an antibacterial soap (such as Dial® or Safeguard®) to wash the area to be treated to reduce your risk of infection.
Get a good night’s sleep, and eat a good breakfast before your visit. Bring a book or something to keep you busy, since you may be here a full day. You might even have to return the next day.
Please bring along any letters of referral or other health forms that your doctor has given you. Also, if you are the patient’s legal guardian or have been named as their Power of Attorney for Health Care, you will need to bring legal paperwork with you that shows this. Treatment may need to be rescheduled if we do not have the correct paperwork.
Mohs Surgery Safety Guidelines
Children are not allowed in the treatment area, unless they are patients.
Only patients are allowed in the treatment room; unless there is a reason for someone to be with you, and it has been approved by our staff. That person may be in the room for part of the exam and then will be asked to wait in the waiting room until staff escorts the person back to the room. All other family members and friends will need to remain in the waiting area.
Please bring a complete list of current medicines. Include the dosage and number of times taken per day.
Warfarin, Plavix®, aspirin, ibuprofen and many other drugs may interfere with blood clotting and cause problems. If you are taking one of these medicines, please call the doctor who prescribed it to see if any medicine changes are needed before your surgery.
Check with your doctor before stopping any prescribed medicines. On the day you are scheduled for Mohs surgery you should take all your normal medicines unless told not to by your doctor.
A small number of patients may need antibiotics before any skin surgery (such as those with artificial heart valves or with artificial joints). If you must have antibiotics or think you may need them, please have your primary, heart, or orthopedic MD prescribe them in advance to avoid delays when you arrive.
You should also bring a list of past and present health problems and surgeries. Include the date done (if known). We will also need to know if you have any implanted devices such as a pacemaker or defibrillator.
What happens on the day of surgery?
After checking in at Mohs Surgery, we will need to obtain a brief history – medicines, allergies, and vital signs (blood pressure, pulse, breathing rate). You will then be checked by a doctor. If treatment is needed, we will “numb” the area. After the tissue is removed, any bleeding will be stopped and the area will be bandaged. A nurse or assistant will be with you during this time. You will be given instructions for wound care, and you will be told at what time your report will be ready.
Next, your doctor will look at your tissue under the microscope, and you will be told the results. If you have a cancer, and all the “roots” are not removed, you will need to return to the treatment room, and more layers of tissue will be taken. This process is repeated until all the cancer is removed.
How long does Mohs Surgery take?
Most often, treatment of one skin cancer can be done in one day. If the cancer is large or if there is more than one site to be treated, the treatment may take more than one day and, in some cases, many visits.
How large of a wound is left?
The size of the final wound depends on how far the “roots” of the cancer extend. Only enough tissue is taken to reach a cancer-free margin or normal tissue.
How will the wound heal?
After all the cancer is removed, your doctor will decide on the best approach to healing. This includes natural healing, closing with sutures, skin flaps, grafts, or plastic surgery. Each way of caring for a wound has its own pros and cons. The final choice depends on many factors such as the kind of cancer, site, size of wound, your health, and what you expect of the results.
What will it look like after the wound has healed?
All forms of skin cancer treatment will leave a scar. This is also true with Mohs Surgery. After the early healing, the wound may be red and raised. This will most often flatten and fade, often taking six months to a year. Most wounds heal very well and are acceptable in the way they look.
Will I need plastic surgery?
At times, the final defect or scar may require surgery to repair looks or function. If it is clear before starting Mohs Surgery that a repair will be needed, this will be discussed with you. At times, we may wish to delay Mohs Surgery until you have been seen by a doctor in Plastic Surgery or Oculoplastic Surgery Clinic (repairs to the eye) so the repair may be scheduled before the Mohs Surgery is started.
If a repair is needed once Mohs Surgery is done this can often be set-up for a later time. This can be arranged through UW Hospital or through a doctor of your choice. At times, plastic surgery is not done until a few months after the Mohs surgery.
Will I have to return for follow-up visits?
After a skin cancer is removed, you will need routine follow up skin exams. these visits allow for a check of the site where the skin cancer was teated, as well as a skin check for any new lesions of concern. these follow up visits may be done in our office, by your local or referring dermatologist, or by your primary doctor.
We may suggest that patients with benign (not cancer) lesions and those with no recent skin cancer be followed by a general dermatologist or their local doctor. This allows the Mohs surgeons to focus their time and use of appointments on patients needing skin cancer treatment.
How can I prevent new cancers from forming?
Since most skin cancers relate to fair skin and sunlight damage, you should avoid too much sun and sunburns. Use a sunscreen with a high sun protective factor (SPF over 15), wear a hat, and stay out of the midday sun. We will have fact sheets for you in our clinic on sun protection and sunscreen use.
What if the growth that brings me in is not a cancer?
Many growths of the skin turn out to be benign. Although your doctor can most often tell which growths may be cancer and which are not, sometimes a biopsy is needed. At times it may be best to remove benign growths because they are easily irritated. Risks of taking off benign growths are about the same as for taking off cancers. The risk of not doing a biopsy of a suspicious skin growth could result in the delay of a cancer diagnosis.
How are billing and prepaid health insurance handled?
Billing from Mohs Surgery is based on standard fees, and is handled through UW Medical Foundation and the hospital billing department. Medicare is accepted for all treatments. Insurance most often covers the surgery, but this will depend on your plan.
Removals of non-cancerous growths that are done for cosmetic purposes may not be covered by Medicare or your insurance. You may wish to check with your insurance company if this is of concern to you.
If you are being referred under a prepaid insurance program (such as Dean HMO and Group Health) we may not be allowed to treat any condition that has not been requested by your doctor. Please make sure you have the referral taken care of before your visit with us to avoid delays in your treatment.
If you have questions with regard to the doctors’ billing, call the UW Medical Foundation billing office at (608) 833-6090.
If you have questions with regard to the clinic billing, please call (608) 262-2221.
If you have any questions about your visit, please call the clinic where you were seen.
Mohs Surgery and Dermatology Clinic
451 Junction Road
Madison WI 53717
(608) 263 6226
1-800-323-8942.
Mohs Surgery and Dermatology Clinic
5249 E. Terrace Drive
Madison WI 53718
(608) 265-1288
1-800-323-8942
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 01/04/2012
Copyright © 12/29/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #4616
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