Boasting a 98-99% cure rate, Mohs surgery is used to treat basal cell carcinomas and squamous cell carcinomas, as well as certain types of melanoma. As a fellowship-trained Mohs surgeon with over two decades of experience helping patients with skin cancer, Desiree Ratner, MD, in New York City treats men and women at her practice in Manhattan’s Murray Hill neighborhood. If you need Mohs surgery for a skin cancer that requires removal, make an appointment for a consultation by calling the office today.
Mohs surgery, also known as Mohs micrographic surgery, is named after Frederic E. Mohs, who developed the procedure as a medical student in the 1930’s. This technique, which came into widespread use in the 1970’s, is a specialized surgical procedure used to remove skin cancers, usually basal cell carcinoma and squamous cell carcinoma.
Of all the treatments for skin cancer, Mohs surgery offers the highest cure rate (up to 99%) and the lowest chance for regrowth. It minimizes the potential for scarring and is the most exact and precise method currently available for removing skin cancer.
Skin cancers often have roots that are not visible to the naked eye but are visible microscopically. Mohs surgery combines surgical removal of the skin cancer and a narrow margin of tissue surrounding it with immediate microscopic examination. This specialized surgical technique allows 100% of the margin around and under the skin cancer to be examined microscopically to make certain that all of the roots have been removed. It is the only technique available that ensures that all of the skin cancer is removed while sparing normal healthy tissue to the greatest degree possible.
Dr. Ratner performs Mohs surgery in the comfort of her office, rather than in a hospital setting. The area of the skin cancer is marked with a sterile marker and numbed with a very tiny needle. This area is then scraped with an instrument called a curette. The curette is a scraping tool that takes advantage of the face that skin cancers are softer than the surrounding skin. When the skin cancer is scraped away with the curette, many of the cancer cells scrape away, while the normal tissue does not scrape away at all. This allows the margins of the skin cancer to be more closely estimated. The skin cancer is then removed with a very narrow margin of normal appearing skin around it.
Dr. Ratner creates a map of the removed tissue to be used as a guide to the precise location of the cancer cells, and then sends the specimen to the lab for processing, which may take several hours. A temporary bandage is placed over the wound, and you will be escorted to the Mohs surgery waiting area, where you can read, relax, or have something to eat or drink.
After the lab has processed the tissue, Dr. Ratner will look at your slides under the microscope. If any skin cancer remains, she will take another thin layer of tissue only from the specific area where the cancer cells were detected. That tissue will again be processed so that the area can be microscopically examined for cancer cells. This procedure continues layer by layer until the skin cancer is completely gone. It may take anywhere from two hours to six or seven hours to complete this process, particularly if more than one layer of tissue needs to be removed.
While most patients go home by lunchtime, others may occasionally need to remain in the office until the late afternoon or early evening if more tissue requires processing.
After all of the skin cancer has been removed, Dr. Ratner will most likely repair the surgical wound with stitches under local anesthesia. She is well versed in skin and soft tissue reconstruction, and makes every effort to hide the incision lines within the natural lines of the face to achieve the best cosmetic result possible. If the wound is small, it may be allowed to heal on its own. Larger or more complicated wounds may require repair by another surgical specialist.
You will go home with a pressure bandage over the surgical site, which will remain in place for 24 to 48 hours. After the bandage has been removed, you or a family member or friend will perform wound care to the site, which is quite simple to do, twice daily. All wound care instructions will be discussed with you and given to you in written form after the surgical procedure has been completed.
Stitches are normally removed in Dr. Ratner’s office in one to two weeks. After the stitches have been removed, butterfly tapes, also known as Steri-strips., are placed over the surgical site and left in place until they fall off, usually within two days to two weeks. These tapes provide extra support to the wound after the stitches have been removed.
While most patients are back to their normal activities after two to three weeks, it is important to remember that surgical wounds take 6 to 12 months to heal completely. Dr. Ratner will most likely want to see you several weeks after surgery, and may see you once or twice thereafter to make certain that you are healing properly. She will then send you back to your general dermatologist for regular skin checks.
You may be a good candidate for Mohs surgery if:
Your skin cancer is large If you have skin cancer, call Dr. Ratner’s office to schedule an appointment and find out if Mohs surgery can help you.