Academic Dermatology

What Is MOHS Micrographic Surgery?

This procedure was first developed in the 1930s by Dr. Frederick Mohs, a professor of surgery at the University of Wisconsin. Mohs micrographic surgery is distinct from routine surgical excision. Standard surgical excision allows for delayed examination of approximately 1% of tissue margins. Since only a small percentage of margins are evaluated, residual tumor may be missed. If more cancer cells are found to remain during delayed pathologic examination, a second surgical procedure will be required at a later date.

Mohs surgeons are dermatologists who have performed additional fellowship training to become experts in Mohs micrographic surgery. Fellowship-trained Mohs surgeons are highly skilled in all aspects of this technique, including surgical removal of the tumor, pathologic examination of the tissue, and advanced reconstruction techniques of the skin. Dr. Whitney Tope is Mohs fellowship-trained and a member of the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO). This official national organization maintains the high level of training and quality of care of this sub-specialty.Dermatologist treating a patient

Mohs micrographic surgery is a highly specialized, state-of-the-art technique used for the treatment of complex skin cancers. Mohs micrographic surgery (MMS) was created by Dr. Fred Mohs when he was a medical student over fifty years ago. It is a meticulous and precise surgical technique used for removing skin cancers. This procedure has gained wide acceptance for skin cancer treatment in the last 25 years. The name “micrographic” comes from “micro”, indicating the use of a microscope to examine tissue, and “graphic”, indicating that a detailed map or drawing of the tumor is made during the treatment. With the Mohs technique, surgically removed tissue is carefully mapped, color-coded, and thoroughly examined microscopically by the surgeon on the same day of surgery. During this process, 100% of tissue margins are evaluated to ensure that the tumor is completely removed prior to repair of the skin defect. Mohs micrographic surgery therefore results in the highest cure rate for complex skin cancers while minimizing the removal of normal tissue.

Preparations for Mohs Surgery

Dr. Tope and his staff like to have a pre-surgical consultation with each patient prior to performing Mohs surgery for skin cancer. This pre-surgical consultation may occur during an appointment or by telephone.

At an appointment we will evaluate your medical history, examine your skin cancer, review how the day will go, and answer any questions you may have. If you are unable to come in for an appointment, we can perform a phone consultation before your surgery date. Prior to the phone consultation, we need your biopsy report to confirm your diagnosis. Typically your referring physician will already have sent us a copy of your biopsy report. Otherwise, you as a patient may provide this report if you have a copy. If you have already undergone Mohs surgery before, we will call you to ensure we have your biopsy report and answer questions relevant to your scheduled Mohs surgery.

Prior to your surgery, we strongly recommend you review the following information sheets.

  • The Mohs Surgery Patient Guide will answer the most commonly asked questions and explain the procedure in detail.
  • The Wound Care Supply List will ensure you have the materials you need to properly care for your wound after your surgery.

Wound Care Instructions

  1. Your surgical wound will be covered by a pressure dressing. You may remove the dressing after _______ hours. Try not to get the pressure dressing wet during this time period.
     
  2. Rarely, your wound may begin to drain fluid or bleed within the first few hours of surgery. If this occurs, apply direct pressure to the bleeding site, over the pressure dressing, with a clean bandage or cloth. Keep constant pressure on the site for 15 minutes. Time this using a clock. Release pressure. If the wound continues to bleed, call Dr. Tope’s office at 952-746-6090.
     
  3. Beginning _______ you may shower, but keep the bandage on the wound while you are in the shower. The bandage may get wet in the shower. Do not immerse the wound in a bath tub. Remove the bandage after showering and follow Wound Cleaning and Dressing Change Instructions
     
  4. If you have discomfort following surgery, take Extra Strength Tylenol or _______ with food. If this does not control your discomfort, call Dr. Tope’s office at 952-746-6090. DO NOT drink alcohol or take aspirin or non-steroidal anti-inflammatory medications: ibuprofen (Advil, Motrin), naprosyn (Aleve) and indomethacin (Indocin), as these drugs thin the blood and increase the risk of post-operative bleeding. Know that aspirin is found in many pain relievers and cold medicines, such as Exedrin, Bufferin, Emprin, Anacin, and Alka-Seltzer. Supplements such as garlic, vitamin E, gingko biloba and Echinacea also thin the blood and should be avoided during wound healing. 

    *If you have already been advised by your doctor to take aspirin, coumadin, or anti-platelet medications (Plavix), we will give you specific instructions regarding your use of these medications.
     
  5. Tissue swelling immediately after surgery is usually due to the injection of local anesthetic. This resolves within a few hours. Some swelling will occur at and around the surgical site and may last for several days due to normally increased blood flow and inflammation which support wound healing. Swelling is worst in the morning when you have been lying down all night and lessens during the day when you are upright. Swelling may be lessened further by:
    • Keeping your wound elevated above your heart, this may require that you sleep upright in a chair or on pillows
    • Applying an ice pack to the site for 10-15 minutes every hour while awake for the first 48 hours
    • Avoiding salty foods
  6. Avoid strenuous exercise, bending over, or heavy lifting for _______ days. These activities increase blood pressure and may cause bleeding or rupture of sutures. Inform Dr. Tope if you expect to swim before your sutures are removed.
     
  7. Change the wound dressing _______ daily, beginning _______ hours after surgery. Make sure to clean the surgery site and change the dressing after you shampoo/shower.

Wound Care Supply List

Please ensure you have the following supplies prior to your day of surgery.

  1. Hydrogen peroxide solution
  2. Cotton swabs (q-tips)
  3. Vaseline or petroleum jelly
  4. Telfa pads or any non-stick dressing
  5. Paper tape
  6. Gauze pads (3 inches x 3 inches)
  7. Ice pack or frozen vegetables that have been placed in a zip lock bag and then wrapped in a cloth (ice in plastic should not be put directly against skin)
  8. Extra strength Tylenol (acetaminophen)

Download Wound Care Supply List.

For more information on MOHS Surgery in the Edina, MN area call Academic Dermatology at (952) 746-6090 today!