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Mohs Surgery: Indications, Procedure, Benefits, Cost, Risks, Recovery, and Reconstruction

September 6th, 2022 | 4 min. read

By Taylor DeBusk, MD

More than five million basal cell carcinomas and squamous cell carcinomas are diagnosed each year in the United States. There are many treatment options available ranging in severity from chemotherapy, radiation, and surgery with a 90% success rate for those diagnosed with skin cancer.

What is the Mohs procedure?

Developed in the late 1930s by Frederic E. Mohs, MD, chemosurgery was used to treat different types of skin cancers. Though it was not widely understood at the time, later studies showed the potential benefits chemosurgery could have in dermatology. 

Now known as the Mohs procedure, it is the most effective surgical technique for treating skin cancers. The Mohs procedure is a surgical procedure performed by a licensed professional. However, it is less invasive than other options and does not require the patient to be put fully to sleep.


What are the indications for Mohs surgery?

Mohs surgery is a specialized treatment approach for specific types of skin cancers. The Mohs procedure is commonly used to treat patients that have been diagnosed with two common types of skin cancer - basal cell carcinoma and squamous cell carcinoma. Though this treatment option has a high success rate, it is not a viable option for all skin cancer patients. 

Indications for Mohs surgery include:

  • Aggressive pathology of cancerous cells
  • Larger cancerous tumor
  • Cancer cells formed in an area with little to no tissue behind it like the eyelids, nose, scalp
  • Cancer cells in areas of importance to protection, like the hands, feet, and genitals
  • Recurring cancer that has been previously treated with chemotherapy or radiation
  • The patient has a weakened or compromised immune system


Which cancer(s) is best suited for the Mohs procedure?

The most common types of cancers  Mohs surgery treats are basal cell carcinoma and squamous cell carcinoma. It may be used to treat other qualifying cases of cancers.

The Mohs procedure is used to treat:

  • basal cell carcinoma
  • squamous cell carcinoma
  • melanoma
  • dermatofibrosarcoma
  • extramammary Paget’s disease
  • Merkel cell carcinoma


Mohs procedure

Millions of Americans are diagnosed with skin cancer each year yet there are less than one million Mohs procedures performed. Mohs surgery is not a treatment option available for all skin cancer patients, but it is very effective for those deemed eligible.

Performed during an outpatient appointment under local anesthetic, the Mohs procedure is conducted through sequential movements of carefully removing the cancerous tumor and a layer of tissue surrounding the area. The surgeon uses medical-grade colored dyes to map out the areas of tissue that have been cut for removal to ensure they are preserving as much healthy tissue as possible.

The tissue that has been removed is frozen, carefully placed on a sterile glass slide, and examined closely under a microscope by a lab expert to determine the presence of cancerous cells or clear margins. Removing, freezing, and examining the specimen can take up to one hour per sample removed.

The Mohs procedure can be lengthy, depending on the extent of the skin cancer. Once the procedure has been completed, your surgeon will bandage the area and provide specific instructions regarding how to care for the area.


How long does the Mohs surgery take?

The length of time it takes a surgeon to perform the Mohs surgery varies depending on many factors, like how long it takes to numb the area, how large the cancerous area is, how long the pathology takes to inspect the specimen, and how many tissue samples must be removed to be sent for testing. On average, patients can expect to be at the doctor’s office for at least 4 hours for the procedure.


Is Mohs surgery painful?

Mohs surgery is performed while the patient is awake under a local anesthetic that is injected into the tissue surrounding the cancerous tumor to numb it. There is an increased level of anxiety for many patients as they fear the pain accompanied by being awake while their surgeon is cutting away layers of tissue. Most patients report the pain during the procedure being minimal.


What are the benefits of Mohs surgery?

Surgery is scary in any sense, but surgery while awake makes it ten times worse. The Mohs procedure offers unmatched benefits, including:


much does the Mohs procedure cost?

In comparison to other treatment options, the Mohs procedure is very cost-effective. The final cost varies based on the size of the cancerous tumor, how much tissue must be removed, and the price set forth by your surgeon for the in-office procedure. The average cost is around $2,500. This price point is much more affordable when compared to other treatments that have lower success rates.


Does insurance cover Mohs Surgery?

Most insurance plans provide Mohs surgery coverage, including Medicare.


What is the Mohs surgery success rate?

The success rate for treating skin cancers with the Mohs procedure is significantly higher than other traditional treatments like radiation and chemotherapy. Surgeons using the Mohs procedure can ensure the accuracy of results as they are removing a tissue sample, sending it to the lab for microscopic inspection, and repeating the process until all margins have been deemed clear of cancerous cells.

For new-onset skin cancers like a newly diagnosed basal cell carcinoma or squamous cell carcinoma case, medical professionals are seeing 99% cure rates while skin cancers that have been previously treated with other treatment options yield a 94% cure rate.


Mohs surgery risks

As with any medical intervention, there are risks associated with the Mohs procedure. During and after the surgery you may experience tenderness or pain where the surgeon is cutting away tissue. Bleeding is expected, and infection is possible if the wound is not properly cared for.

Less common risks include:

  • Nerve endings in the skin being cut, resulting in numbness that may be temporary or permanent.
  • Muscle nerves being cut during surgery, leaving you to experience temporary or permanent weakness (especially in the hands and feet).
  • Poor wound healing is commonly seen in patients with underlying health conditions like diabetes that affect the healing process.
  • Cosmetic deformities at the site where a tumor was removed (near the eyes, nose, ears, lips, etc).
  • Larger scarring than normal for large cancerous tumors.
  • Shooting pains.
  • Tumor regrowth, which is common in recurrent skin cancer cases.


Mohs Procedure Recovery

Although the Mohs procedure is a less-invasive surgery to treat skin cancer than others, it still involves the surgical removal of layers of skin and tissue. After all of cancer has been removed and the pathology reports clean margins under a microscope, the surgeon will discuss options available to you in caring for the wound.

The wound will typically heal on its own through proper bandaging and ointment application. On occasion, a few stitches are needed depending on how large the affected area is.


Post-Mohs Reconstructive Surgery

In some cases, plastic surgeons perform special reconstructive procedures to restore function and form to the area and optimize healing. For more serious cases of skin cancer in sensitive areas, a plastic surgeon may determine the need for skin graft surgery in a post-Mohs reconstructive surgical procedure.


Treating Skin Cancer at Houston ENT & Allergy

When it comes to plastic surgery, you want the best without compromising safety. At Houston ENT and Allergy, our surgeons are highly skilled in the latest techniques to treat aging skin, hair restoration, and facial plastic surgery to enhance your appearance and boost your confidence. 

Our doctors are committed to providing personalized attention to each patient to formulate a treatment plan using the most advanced technology. 

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