Mohs Micrographic Surgery: Smaller Scars, High Cure Rate

Mohs Micrographic Surgery: Smaller Scars, High Cure Rate


– [Narrator] Welcome to
Dartmouth-Hitchcock’s section of dermatology. In the next few minutes, we
will help explain Mohs surgery, its advantages and risks,
and what you can expect before, during, and after the procedure. Mohs micrographic surgery is offered at three Dartmouth-Hitchcock clinics, at the Heater Road facility
in Lebanon, New Hampshire, and in the Manchester, and
Keene, New Hampshire clinics. It is a highly specialized procedure used to remove skin cancers from the face, head, neck, and shins, and for removing larger tumors on the abdomen, legs, or arms. – The primary application of Mohs surgery is in the treatment of
non-melanoma skin cancers. Basal cell carcinomas, and
squamous cell carcinomas account for about 90% of those cancers. – There are dozens of other types of less common skin cancers out there that are indications for Mohs surgery but the majority of tumors are basal cell and
squamous cell carcinomas. – [Faramarz] The advantage of Mohs surgery is that it produces a smaller scar, at the same time, the
highest possible cure rate. – For a basal cell carcinoma, the cure rate is around 98 to 99% for a primary basal cell tumor, that’s one that hasn’t
been operated on before, and for a primary squamous cell carcinoma, the cure rate is approximately 97 to 98%. – The way it stands right now,
if you don’t do Mohs surgery, the recurrence rate of those kinds of very common tumors is quite high, and you don’t want that on the face. – [Narrator] Mohs surgeons are trained to understand how skin
cancers appear and grow, how they are removed, and how they appear under a microscope. They can determine the least
amount of tissue to be removed thereby reducing scarring while efficiently removing the cancer. – Skin cancer is interesting. What we see on the skin, how
large a lesion or tumors looks on the skin may not be how
large it is underneath the skin. In other words, it may be bigger. It may be twice as big under
the skin than what we see. – I tell patients that skin
cancers are like trees, and we can see the trunk
and branches on the surface much like we can see
the surface of the tumor on the surface of your skin
but we can’t see the roots that are below the ground, or the roots, or finger-like projections
of some of these skin cancers that are below the skin,
so by doing Mohs surgery, when we take a cut around the tumor, and are visualizing it
under the microscope, I’m able to find the
extensions of these tumors under the deeper levels, or
the dermal layer of the skin, and follow them, and keep
removing those sections until they’re all gone. – [Narrator] If you have been
scheduled for Mohs surgery, try to get a good night’s
rest the night before, and eat a good breakfast before arriving for your appointment. Take any of your prescribed medications unless otherwise directed. If you are taking aspirin
for blood clotting, or a heart condition,
please continue to take it. Otherwise, avoid any aspirin
or aspirin-containing products for 10 days prior to your surgery. It is also important to avoid alcohol. By the day of your surgery,
your doctor will discuss the things you need to
prepare for recovery. – During a preoperative consultation, we review wound care
instructions in detail. We review the supplies that patients need, and exactly what they can expect in the postoperative period. – Once the consent form is signed, the patient is then prepped for surgery. – Nancy. – [Nancy] Yes. – [Lisa] You may come with me. – All right. – [Lisa] Good morning. – [Lisa Voiceover] We bring
them back to the room. We go over their name,
their date of birth. – Nancy Smith. – We do their vital signs. We go over their history with them. We go over their medications or allergies. We get them into a
hospital gown and a robe. – [Robert] We also mark the
spot with a surgical marker, and have the patient confirm
that that is in fact the spot that we are treating that day. – Do you agree that this
is the correct spot? – That’s it. – Perfect. – [Lisa Voiceover] We
give them a warm blanket. We have them positioned
comfortably on the table. – At bed time, a local numbing
medication called Lidocaine is injected into the site. Lidocaine minimizes pain
during skin surgery. This allows us to take the first stage. – [Narrator] During the
Mohs surgery procedure, the surgeon will first
remove any skin cancer that is visible to the naked eye. This is typically done by
cutting with a scalpel, or scraping with a round
blade called a curette. Then to find out if the
cancer has microscopic roots, a thin ball-shaped layer of
skin is cut from around the area where the original visible
cancer has been removed. This sample is then taken
to the lab for processing by a technician called
a histotechnologist. – The ashes are 12, 3, 9 for orientation. – All right. – And I’ll be in my office
when you have a tissue or set. – Okay.
– Thank you. – Thank you. – [Faramarz] They freeze the tissue. Subsequently they cut the
tissue into very thin slices that are placed in glass slides. Tissue is then stained, and then these slides are
viewed utilizing a microscope. – [Narrator] The surgeon
reviews the slides, and will be able to identify
if any of the cancer has spread beyond what
was already removed. While the skin is being
processed in the lab, and the surgeon review the samples, the nurse will temporarily
bandage over the wound, and at that time, you can
choose to stay in the room, and take a nap, read a
book, listen to music, or return to the waiting area, and visit with family or friends who may have accompanied you. – For a one-stage procedure, it can take up to two hours, however, from more complicated cases, it can take up to three,
four, even five hours because it takes one hour for
each stage to be completed. – [Narrator] If the doctor
sees additional cancer under the microscope, he or
she will mark its location on a map of the original sample. You will be brought back
into the procedure room. The temporary bandage is
removed, and using the map, the surgeon will then cut an
additional margin of skin, and send it back to the
lab for further analysis. The lab will prepare the new sample, and the surgeon will again
check for any additional cancer. – I keep repeating that process
till the tumor is all gone, so the good news, again when
the patient leaves the office, they know that their
tumor is gone that day. Now once I come back in the room and say, “Good news, cancer is all gone,” there’s typically a
hole or surgical defect from where we removed the cancer, and we don’t let people leave here with a hole in their face or ear or nose. We repair it for ’em that day. – All wounds can heal on their own, however, under certain
conditions or settings, it may be detrimental to allow
the wound to heal on its own in the sense that it
could take longer to heal, or it could result in a
poorer cosmetic outcome, or it could be associated
with increased pain during the healing process. – And depending on the size
of that surgical defect, and how it affects other
anatomic structures, depends on how we close it. – [Narrator] For smaller tumor removals, the doctor will sew the skin together, and only a fine line scar will result, however, if the wound is
larger, skin may be borrowed from areas elsewhere on the body. This is commonly known as skin grafting, and also results in minimal scarring. Minimizing scarring is
one of the main advantages of having Mohs micrographic surgery as opposed to other types
of skin cancer removal. – If the wound is particularly large, we then ask our plastic surgery colleagues to lend us a hand. Usually this takes place
in the operating room, and it usually occurs within a day or two of the Mohs procedure. – But this is rare, and most
often unneeded, unrequired. – [Faramarz] After the
wound has been repaired, we typically apply a pressure dressing that stays on the wound
for about 48 hours, and the purpose of this
dressing is to decrease swelling at the operative site. – [Narrator] Should you have
any questions or concerns during the postoperative
period, you are encouraged to call the dermatology office right away, and either speak with a nurse,
or schedule an appointment in order to address those concerns. – During the recovery period, patients can experience
some degree of pain, which is usually relieved with Tylenol. – The risk of Mohs surgery is the same as with any other surgery. There is no different than
doing non-Mohs surgery to remove a skin cancer. There’s always a bleeding risk. There’s 100% chance of a scar. There are complications such as infection, which are rare but do happen. – For us at Dartmouth-Hitchcock, risk of infection is less than 1%. Similarly the risk of
bleeding is quite low. – Recurrence meaning the tumor coming back to the same exact location, 1%,
so this has a 99% cure rate. There’s very rare risks of
nerve, artery, or tendon damage depending on where you’re operating but those are much less than 1%. – Often patients ask about how much pain they’re going to experience after surgery. Surprisingly they typically
experience very little pain, and if they do experience pain, this pain is generally well
controlled with Tylenol. – [Narrator] Dartmouth-Hitchcock
performs approximately 1,000 to 1,500 cases of
Mohs surgeries per year, and it is performed five days a week. For additional information, you can visit dartmouth-hitchcock. Org, and download the complete
Mohs surgery guide. (light music)

11 Comments

  • fenotipobombay says:

    really can dermatologists perform such operations of plastic surgery? Is this legit?!

  • Cameron Hamill says:

    Thank you so much for this excellent video. You have provided a great public service. I may have to undergo MOHS and you have put my mind at ease. Thanks very much once again.

  • mrnibelheim says:

    Very helpful, thanks!

  • karey lester says:

    So they have to keep numbing you i hope!! I need propofal

  • Happy Hour says:

    Getting ready to go in for my Mohs procedure tomorrow (not with this clinic). My basal cell is between my nose and cheek, just under my eye. It hurt bad enough when they injected the lidocaine prior to the biopsy, due to the sensitive area. Now that I have an open wound, I don't even want to imagine the pain of injecting lidocaine near the open wound area. I wish they would have just done the Mohs surgery the first time and got it all over with at once rather than doing a biopsy first, and coming back later. But I suppose since Mohs surgery is so time consuming, they might have wanted to be certain it was necessary. Can't believe I am in my thirties, and already have skin cancer. I'm terrified, but the way this video explained the procedure, I feel somewhat better. If anybody is reading this who uses tanning beds and never uses sunscreen, STOP. Trust me, even if basal cell generally is not aggressive and doesn't spread, this entire process is very terrifying, and who wants to have their face cut open??? Take care of your skin, and don't be an idiot like me. A tan is only pretty for a few years. When you get to be my age, and have skin cancer, it isn't pretty anymore.

  • Barb Salame says:

    This should be mandatory viewing for anyone wishing to use a tanning bed….exxcellent video!

  • Adam Howard says:

    Just had this procedure. I look like Mike Tyson punched me in the eye without boxing gloves. Lol

  • Pamela Sylvester says:

    I will be having this surgery this month on my lip this gives myself some hope for the to e being great video

  • Tube Valve says:

    Curaderm does it 100%, required a bit more time and patience, but it is not so invasive and works in-depth of cancer tissues.

  • srivera28 rivera says:

    Thank you for this video Although very scared for the surgery, I am more informed thanks to this video.

  • Tom Cat says:

    I have had 7 moh's surgeries. 2 this year. 1 below eye in July and 1 last week on nose. I wont have any skin left in a few years. I am debating on curaderm next time.

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