At the time of the pre-operative consultation, the Mohs surgeon will inform the patient of the steps involved in the surgery.
Texas Surgical Dermatology, led by board certified dermatologist Dr. Tri H. Nguyen, provides medical and cosmetic dermatology procedures to patients in Houston, Katy, Spring, The Woodlands, Texas, and surrounding locations.
Sequential Steps in Mohs Surgery
Depending on the location of their skin cancer, the patient may be able to wear their regular clothing or may need to put on a hospital gown.
The Mohs surgeon will assess the site where the patient had their biopsy and demarcate if with a pen for reference. They will then position to the patient to gain access to the treatment area, including having them sit up or lie down.
A surgical drape will be placed over the treatment area. If the cancer is on the face, the patient may be unable to view the proceedings. But the surgeon will talk them through it. They will then inject a local anesthetic to numb the area entirely. The patient will remain awake throughout the procedure.
The surgeon uses a scalpel to remove a thin skin layer with visible cancerous tissue. In some types of skins cancers, this may only be the “the tip of the iceberg.” This means that they have roots or extensions that are not visible from the surface.
The ensuing lab analysis will establish whether this is the case. The surgeon will bandage the wound temporarily, and the patient can relax as the lab work begins.
The surgeon will dissect the tissue into multiple sections and color code them using dyes. They will also create a map of the surgical region. The lab technician will then freeze the dissected tissue and slice it into very thin horizontal strips similar to a layer of cake.
Subsequently, these slices are mounted on microscopic slides, stained, and covered. This is a laborious and time-consuming process.
The surgeon will assess all the sides and the underside of the tissue mounted on the slides. If any cancer cells remain, they will mark the location on the map. After this, the surgeon will let the patient know if they will need to have another layer of tissue removed.
The doctor will administer more local anesthetic in the operating room if necessary and eliminate another skin layer in the area where the cancer cells remain based on the map. Then the patient will wait again as the lab work commences. This process will be repeated until no more cancer cells remain.
Depending on the location and size of the treated area, the surgeon may leave the wound open to heal or suture it after no more cancer cells remain. At times, the wound may need reconstruction using a skin flap. The surgeon will move the nearby tissue into the wound or use a skin graft.
For most patients, the Mohs surgeon will repair the wound immediately after attaining cancer-free margins. But sometimes they may repair the wound working with another specialist.
The patient may need to spend several hours on this surgery, especially if more than one or two rounds of skin removal are necessary. The benefit of this precise technique is that it has the highest rate of cure of any treatment technique and preserves the most amount of healthy tissue possible while leaving behind the smallest scar.
Board certified dermatologist Dr. Tri H. Nguyen receives patients from Houston, Katy, Spring, The Woodlands, Texas, and nearby areas for advanced dermatology procedures.
For more information on procedures and treatments offered at Texas Surgical Dermatology PA please call 832.663.6566 or click here to contact our dermatologists. Helping patients in Houston, The Woodlands, Springs, Katy and other surrounding areas of Texas.