Mohs surgery is a highly effective procedure for treating certain types of skin cancer, like basal cell carcinoma and squamous cell carcinoma. One of the most common questions patients have before undergoing this treatment is about the amount of skin removed due to the surgery. Since the procedure aims to remove as little healthy tissue as possible, the amount of skin removed varies based on the size and depth of the cancerous area.
What Is Mohs Surgery?
Mohs surgery, developed by Dr. Frederic Mohs in the 1930s, is a precise surgical technique used to remove skin cancer layer by layer. Unlike traditional methods, Mohs surgery ensures that only cancerous tissue is taken out, minimizing the removal of healthy skin. The goal is to leave behind the smallest scar possible while ensuring all cancerous cells are removed.
The procedure is done in stages:
- The surgeon removes a thin layer of tissue where cancer cells are present.
- The tissue is immediately analyzed under a microscope.
- If cancer cells are still present, another layer is removed and examined.
- This process repeats until no cancerous cells remain.
The amount of skin removed in Mohs surgery largely depends on the extent of the cancer. While Mohs surgery is conservative in nature, the total area of skin excised can vary significantly from patient to patient.
Factors That Determine How Much Skin Is Removed
The amount of skin removed in Mohs surgery depends on several factors that are unique to each patient and their cancer:
1. Size and Location of the Tumor
The size of the cancerous area plays a big role in determining how much skin is removed. Larger tumors naturally require more layers to be taken out. Additionally, tumors in sensitive or difficult areas, such as the face or neck, may require extra care to avoid excess tissue removal.
2. Tumor Depth
The depth of the skin cancer affects how much tissue needs to be excised. Superficial cancers often only require a few layers to be removed, while deeper tumors may require more extensive removal. The Mohs surgeon evaluates the depth of the cancerous tissue during each stage of the procedure.
3. Cancer Type
Certain types of skin cancer, like basal cell carcinoma, tend to spread in an unpredictable manner, which can increase the amount of skin removed in Mohs surgery. Squamous cell carcinomas may behave differently, affecting how many layers are needed.
4. Previous Treatments
Patients who have had prior treatments for skin cancer might have scar tissue, which can complicate the procedure. In these cases, more skin might need to be removed to ensure that all cancer cells are taken out.
5. Margins of the Tumor
A crucial part of Mohs surgery is obtaining clear margins—meaning that the edges of the removed tissue are cancer-free. If the margins show signs of remaining cancer cells, more tissue needs to be excised until clear margins are achieved.
What to Expect During the Surgery?
Mohs surgery is performed under local anesthesia, meaning the patient stays awake, but the area being treated is numb. The procedure can take a few hours, depending on how many layers need to be removed. Since tissue is analyzed after each layer, patients may need to wait between stages.
The total amount of skin removed in Mohs surgery is kept to a minimum, thanks to the precision of the technique. This reduces both recovery time and the overall cosmetic impact.
How Much Skin Is Typically Removed?
While it’s hard to provide an exact answer due to the various factors at play, Mohs surgery is generally known for removing much less skin than other traditional methods. On average:
- Small tumors may only require the removal of a few millimeters of surrounding skin.
- Larger or deeper tumors might need several millimeters to a centimeter or more, depending on the size and location.
Because each cancer case is unique, the surgeon carefully evaluates the cancerous area to ensure that only the necessary tissue is taken out. However, the trade-off between safety and cosmetic outcome is always considered.
Post-Surgery Expectations
After the procedure, patients can expect some swelling, redness, or minor discomfort around the treated area. Depending on how much skin was removed, the wound might heal on its own, or the surgeon may close it with stitches or recommend reconstructive surgery if needed.
In most cases:
- Small wounds heal on their own within a few weeks.
- Larger wounds may require stitches or a graft for better cosmetic outcomes.
The healing process is typically straightforward, but the amount of skin removed plays a role in how long recovery takes. Your surgeon will provide detailed aftercare instructions, including how to care for the wound and manage any potential scarring.
Mohs surgery is a highly effective and minimally invasive method for treating skin cancer. The amount of skin removed in Mohs surgery depends on factors like the size, depth, and type of cancer. The procedure ensures that only the necessary tissue is taken out while preserving as much healthy skin as possible. With its high cure rate and minimal impact on healthy tissue, Mohs surgery is often the preferred treatment for skin cancer located in cosmetically sensitive areas.
Frequently Asked Questions
How long does Mohs surgery take?
Mohs surgery can take anywhere from a couple of hours to most of the day. The length depends on how many layers need to be removed and examined under the microscope. Each stage takes about 30 minutes to an hour, and patients may need to wait between layers.
Will I need reconstructive surgery after Mohs surgery?
In some cases, yes. If a significant amount of skin is removed, particularly in cosmetically sensitive areas like the face, reconstructive surgery may be recommended. Smaller wounds often heal naturally or with stitches.
How long does it take for the wound to heal after Mohs surgery?
Healing time varies depending on the size of the wound. Small wounds may heal within 2-4 weeks, while larger wounds or those requiring stitches might take longer. Your surgeon will provide aftercare instructions to aid the healing process.
Does the amount of skin removed affect scarring?
Yes, the more skin that is removed, the greater the potential for scarring. However, Mohs surgery is designed to minimize this by removing only the necessary tissue. Surgeons aim to leave the smallest scar possible, and the location and size of the wound will affect how noticeable the scar is.
Can Mohs surgery be done more than once in the same area?
Yes, if skin cancer recurs in the same area, Mohs surgery can be performed again. The goal of the procedure is to completely remove cancer cells, but in some cases, a second surgery may be necessary.