Mohs surgery, which is sometimes referred to as Mohs surgery micrographic surgery, is directed at treating skin cancer. It entails the removal of cancerous cells along with some margins of surrounding healthy tissue. It has been found effective to limit the need for further surgical interventions in the future. Essentially, Mohs surgery is adopted in addressing the issue of recurring skin cancer. Precisely stating, Mohs surgery has been vastly used in the treatment of squamous cell carcinoma – which affects the outermost layer of the skin – and basal cell carcinoma – which affects the cells responsible for producing new skin cells. Mohs surgery is reported to be the most successful surgical procedure used in treating basal cell carcinoma and squamous cell carcinoma – whether in cases of recurrence or fresh cancerous growth. The two approaches that are employed in carrying out Mohs surgery are the fixed-tissue technique and the fresh-tissue technique.

Mohs surgery may be recommended for a patient under the following circumstances:

• Rapidly growing, large-sized squamous cell cancer with a high risk of recurrence and/or proliferative tendency. This surgical technique can also be used in the instances where the squamous cell cancer is localized around the lips, nail bed, scalp, columella, or canthus.
• Recurrent basal cell cancer with high-risk, violently growing primary tumour. More so, Mohs surgery may be considered when the basal cell cancer emerges at areas that a high risk of recurrence is feasible.
• Aggressively multiplying cutaneous tumours as seen in carcinomas like dermatofibrosarcoma protuberans, keratoacanthoma, sebaceous carcinoma, malignant melanoma, etc.

The first step towards a successful Mohs surgery is the pre-surgery appointment with a surgeon. During this visit, the surgeon will carry out some evaluations. To start with, he/she will explore your past medical history to see if you have had any surgery in the past. Also, the surgeon will seek to know if you have suffered any skin infection, diabetic or cardiovascular complications prior to this particular appointment. All these are done to determine how suitable it is to perform Mohs surgery on you. So, you should endeavour to be as accurate as possible while responding to the questions on your health, and also, be free to ask the surgeon questions where necessary.

Going forward, the surgeon may also have you go through some diagnostic examinations like computed tomography and/or magnetic resonance imaging scans. Histological examinations will be carried to examine whether the cancerous cells have differentiated or not.

Once the condition has been diagnosed and the surgeon has selected Mohs surgery as the best skin cancer treatment course for your condition, he/she will discuss what the procedure entails with you – right from the days leading to the surgery down to postoperative period.

Here are some of the preparation tips you may be given by the surgeon:

• Stop smoking and/or taking alcohol at least two weeks before the date set for your Mohs surgery.
• Avoid taking blood-thinning drugs like Aspirin and Ibuprofen two weeks before the operation. More so, you should let the surgeon know about all the medications you are taking as you prepare for Mohs surgery.
• Supplements such as Vitamins C and E, Ginseng, Fish oil, Ginkgo biloba should be avoided or discontinued one week before the surgery. This measure is to be taken to curtail the incidence of raised blood pressure and excessive blood loss during the operation.
• Dress comfortably.
• Be ready to spend most of your day at the clinic. Given this, you should reschedule every other appointment or meeting that might have been pre-planned for the date of your surgery.
• Make available something – a novel, book, etc. – you can use to while away time as you will be waiting. You should have it at the back of your mind that at some points during the operation, the surgeon will leave you to go run specific tests on the tissue obtained from you. This may take up to an hour or thereabout so, having something to keep you engaged should suffice.

Although Mohs surgery is considerably safe, offering a good prognosis, there are a couple of risks that may result after the operation. Some of these include:

• Infection
• Haematoma
• Nerve damage
• Persistent pain around the surgical site
• Numbness
• Scarring

Mohs surgery is usually done under local anaesthesia and may take about four hours to complete. The two approaches to Mohs surgery are hereby discussed:

Fresh-tissue Technique: The surgeon will draw out marking around the skin cancer and then have the anaesthesiologist administer local anaesthesia to the patient. A curette is then used to debulk the tumour even as the skin margin is marked out. Thereafter, the surgeon will methodically remove the surrounding tissue with a scalpel, ensuring that the extreme margin is excised along with the cancerous cells. To control bleeding, the surgeon will perform spot electrodesiccation thus establishing haemostasis. The surgeon will then move on to the next stage – which is the microscopic examination of the excised tissue. In doing this, he/she will etch out a 2-dimensional map of the skin cancer, and then partitions the tissue in line with the marked margin. The tissue is now upturned with the margins distinguished by colour code. The tissue specimen is then frozen and placed on a slide where it is prepared and thereafter examined under the microscope. A red coloration appearing on the 2-dimensional map signifies the presence of emerging abnormal growth – which could turn out to be cancer. In such a scenario, the surgeon will have to repeat the process until all the cancerous cells are removed.

Fixed-tissue Technique: The surgeon uses a curette to debulk the tumour and then applies a fixative paste to the surgical area. Thereafter, the spot is covered with a surgical dressing for 6 – 24 hours. After this period, the surgeon will proceed to use a scalpel to remove the fixed tissue, going as far as the margin of the unfixed (surrounding) tissue, and then microscopically examine the margin to see if there is any cancerous growth. If there is any skin cancer found, the process of tissue fixation will be repeated. The residual tumour will then be removed, with the surgeon ensuring that no cancerous cell is left untouched. The surgeon may either apply sutures or leave the wound to heal naturally – medically referred to as “healing by second intention”. The surgeon may yet obtain skin graft from other parts of the body to cover the wound – this can also happen with the fresh-tissue technique.

Mohs surgery is primarily an outpatient procedure; this means that you will be able to go home the same day the operation is completed though you will have to visit the clinic for a follow-up to check your recovery status. The surgeon will inform you about the time to remove the surgical dressing – this is mostly taken off within 1 – 2 day(s) after the surgery. That said, the moment after the surgery, you are going to feel mild to moderate swelling and/or pain – this should fade away in a couple of weeks. Nevertheless, you can place cold packs over the surgical site to minimize swelling. Besides this, it is of utmost necessity that you keep to every instruction given by the surgeon, and also use your medications religiously. Again, you should not indulge in smoking for at least 2 weeks after Mohs surgery has been completed.

A follow-up routine can be set up to ensure comprehensive examination of the skin – you can discuss this with your dermatologist or the attendant surgeon. The need for follow-up does not, in any way, undermine the effectiveness of Mohs surgery, but the fact is that individuals who have once had skin cancer may develop another bout of the symptoms of the disorder again in a couple of years – this is especially in cases of aggressively multiplying cancer.

Mohs surgery nearby in India is certainly achievable with the resources and team of surgeons at The Esthetic Clinics. We are a leader in providing reconstructive surgical therapies, adhering to a professional standard that is well-revered in a top clinic across the world. In addition to this, we tap into the experiences of multiple award-winning oculoplastic surgeon, Dr. Debraj Shome, and other notable surgeons within our rank to ensure that you will not only get a satisfactory Mohs surgery outcome but one that would retain considerable cosmetic outlook – our cosmetic surgeons are on hand to ensure this. Mohs surgery has to be performed by the best hands, with a significant level of precision, and these are guaranteed at The Esthetic Clinics.

The cost of Mohs surgery can vary from patient to patient. Certain factors like the severity of a patient’s case and/or tumour size, follow-up, and facility fee will notably determine your Mohs surgery price. Hence, you can only get a detailed cost estimate after your condition must have been carefully evaluated by our team.