Mohs Surgery

Mohs surgery (often misspelled Moh’s surgery) is a technique for removal of skin cancers. Mohs surgery is unique because it allows the surgeon to map and remove not just the visible parts of a skin cancer, but also the roots that can only be seen under the microscope. When used to treat basal cell carcinoma and squamous cell carcinoma, Mohs surgery has the highest cure rate of any treatment. This technique also allows the Mohs surgeon to spare normal skin to minimize scarring.

Mohs surgery is done in stages. After the site is cleaned and numbed, the Mohs surgeon will remove the visible portion of the tumor together with a very small margin of normal skin. The tissue is then processed in the laboratory and viewed under the microscope by the Mohs surgeon. Within approximately one hour the surgeon will have determined whether the tumor is completely removed or whether it is necessary to remove additional tissue. The Mohs surgeon is able to carefully map out the area where the tumor remains and will only remove additional skin in the areas where the margin shows tumor. This process is repeated as many times as necessary to ensure that the tumor is completely removed.

Once the margins are clear the Mohs surgeon will determine which repair will give the best cosmetic outcome and restore normal architecture and function. In some cases the best repair is a simple straight line while in other cases the best repair may require shifting and re-draping skin (flaps) or borrowing skin from a distant site such as the skin over the collar-bone or the skin fold in front of the ear (grafts). Often a great many stitches are required to create the repair that will ultimately give the best appearance once the site is healed.

Clinical studies demonstrate that Mohs surgery provides five-year cure rates of approximately 99% for new basal cell carcinomas, and 96% for recurrent basal cell carcinoma. Cure rates for squamous cell carcinoma are approximately 97%. These cure rates are significantly higher than with other methods of tumor removal or destruction

• Tumors on the face, neck, genitalia, hands, feet, or lower legs
• Tumors on other body sites that may be difficult to repair if too much tissue is removed
• Recurrent (previously treated) tumors
• Large tumors or tumors without clearly defined edges
• Tumors that appear aggressive under the microscope

Deborah Cummins, M.D., at Massachusetts Dermatology Associates performs all Mohs surgical cases with the assistance of her specially trained team, which includes surgical assistants, and a technician that processes the tissue in the laboratory.

Dr. Cummins has trained at Johns Hopkins School of Medicine, completed dermatology residency at Harvard/Massachusetts General Hospital Dermatology residency and has done an additional fellowship specializing in Mohs surgery at Tufts Medical Center. She was previously the Director of Mohs and Dermatologic Surgery at Boston Medical Center. She is board-certified in dermatology and is an Associate of the American College of Mohs Surgery.

“Mohs surgery” (not “Moh’s surgery”) is the proper designation.   Originally developed by Frederic E. Mohs in the 1930s, this technique has been refined and improved over several decades.   It is sometimes improperly spelled “Moh’s surgery”.

ABSOLUTELY NOT. If you take these medically prescribed anticoagulants, then you should continue them during and after surgery. If you are on Coumadin it is important that you have your INR checked the week before surgery and have the results sent to us so that we can ensure that your INR is within normal range.

If you have had a heart attack, a stroke, a blood clot, or if your doctor tells you that you NEED aspirin, then you should NOT STOP your aspirin for skin surgery.

However, if your doctor told you to take an aspirin each day “just because it is good for you” then please discontinue two weeks prior to surgery. If you are uncertain why you are on aspirin, it is always best to contact your primary care doctor’s office before stopping it.

You can resume your aspirin 2 days after surgery.

YES. Both Mohs surgery and surgical excisions are performed with local anesthesia, i.e. injection of numbing medication (lidocaine) into the skin at the surgical site. You will not have general anesthesia or sedation.

YES. Please eat a light meal prior to surgery.

If surgery will be done on the face or leg it is generally best to arrange for someone to drive you home after surgery.

You should take acetominophen (Tylenol) after surgery. We typically recommend that you take an acetopminophen 500 mg tablet as soon as you get home to decrease your discomfort as the numbing medication wears off. The first evening is when patients generally have the most discomfort and so you may want to take two of the acetominophen 500 mg tablets before bed. Most patients do not need more than Tylenol for pain control, but for more extensive surgeries we do occasionally prescribe Tylenol #3 (Tylenol with codeine).   We recommend that you avoid use of aspirin, ibuprofen (Advil), Aleve or other NSAIDs for pain relief as they may increase risk of bleeding.

In most cases you should not resume exercise until after the sutures have been removed. Exercising immediately after surgery increases the risks of bleeding, breaking open the stitches, and poor wound healing. Please avoid water sports for at least one week and also avoid hiking, camping and other outdoor activities that may expose the wound to dirt and infection.

You should make every effort to protect your wound site from the sun because sun exposure can increase the risk of a darkened scar.

You may experience a great deal of swelling and bruising in the first few days to week after surgery, especially with surgeries done on the forehead, near the eyes, or on the nose.

In many cases swelling cannot be prevented. Sometimes elevation of the head helps. When awake sit or stand upright. At night you may sleep with a few pillows or sitting up in a lazy boy. Sometimes carefully icing the wound can also help.

It is normal to have some bleeding onto the bandage. If the bleeding soaks through the bandage, then use clean dry gauze to apply FIRM, DIRECT PRESSURE FOR 20 MINUTES WITHOUT LIFTING UP TO LOOK AT THE WOUND. Depending on the location of the wound you may need someone to assist with holding pressure. If the bleeding does not stop after 20 minutes of pressure please call Dr. Cummins at the general office number.  If it is outside of normal practice hours, you can press a button to be connected with Dr. Cummins.

Hydrogen peroxide is too abrasive for wound healing. It is preferable to clean the wound daily with mild soap and warm water prior to dressing changes.

Neosporin can cause an allergic reaction in some people. We recommend Aquaphor or Vaseline (petrolatum) instead. These may be applied one to two times daily with a clean Q-tip, always from a clean uncontaminated container.

Wound care and bandaging will be reviewed on the day of surgery. In most cases we will recommend a Telfa non-adherent gauze applied with medical tape. For smaller wounds a large bandaid may be sufficient.

This depends on the wound location and the type of repair that you have had. In most cases you will only need to dress it for one to two weeks.

For urgent issues please call the general office number.   If it is outside of normal practice hours, you can press a button to be connected with Dr. Cummins.