Here at Goodskin, you can feel confident that you are in safe, capable hands.

Goodskin Dermatology is a proud provider of Mohs micrographic surgery, an advanced technique for removing skin cancer. Mohs surgery aims to remove not only obvious cancerous skin growths, but the cancer’s elusive roots that tend to hide beneath the surrounding normal-looking skin. The technique is very precise, minimizing the chance of cancer regrowth and the potential for scarring.

MOHS TREATABLE CANCERS

Mohs micrographic surgery is an effective treatment for basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and other rare forms of skin cancer.

Basal Cell Carcinoma is the most common type of skin cancer. It is slow-growing, does not metastasize (spread elsewhere), and is rarely fatal. However, if this cancer is left alone, over the years it can eat away at the nose, lips, ears, or even eyes.

Squamous Cell Carcinoma is the second most common type of skin cancer, and it is responsible for 8,000 – 10,000 deaths annually in the United States alone. This type of cancer also grows slowly, but more quickly than basal cell. The lips and ears are particularly vulnerable areas for squamous cell carcinoma.

Malignant Melanoma is the least common type of skin cancer, as well as the most deadly; it is responsible for 75% of the deaths caused by skin cancer. Melanoma is fast spreading, so treatments yield the best results when the cancer is caught early on in its process.

Undergoing skin cancer surgery can seem more than a little frightening, which is why we do all that we can to make the experience as comfortable as possible. You will be under the hands of an experienced dermatological surgeon who will discuss with you all of your questions and concerns before the procedure begins and help you make a plan for your continued skin care afterwards.

THE PROCEDURE

  • First, a local anesthetic is used to thoroughly numb the area of the cancer growth.
  • Once the area is entirely numbed, the soft part of the cancer is scraped away. The main part of the cancer is often softer than the surrounding skin.
  • A thin layer of tissue (about 2-3 mm thick) is then surgically removed from around and under the area.
  • Green, black, yellow, and red dyes are added to distinguish top from bottom and left from right for when the doctor later looks at them under a microscope.
  • The area is bandaged.
  • Initial results are usually back within 30-45 minutes.

The removed cancerous tissue is frozen, sliced into thin layers, placed on glass slides, and stained. These are then scrutinized under a microscope for remaining cancer, any of which are then marked on a diagram.

  • You will return to the surgery room, where the remaining cancerous tissues will be removed.
  • You are again bandaged and wait while the next set of slides are prepared and examined, as before.
  • You again return to the surgery room, where any remaining cancerous tissues will be removed, and the process repeats itself until, with as much certainty as possible, all signs of cancer are removed.
In some cases, this process can only take only a few hours, depending upon the extent of the cancer.

AFTER THE SURGERY

Mohs surgery is one of the most advanced techniques of its kind, offering you the highest possibility for complete removal of cancerous growth. Afterwards, however, there will be some recovery needed due to the wound left behind from the extraction area. There are a few different ways that this wound can be cared for and repaired, depending upon the extent of extraction:

  • The wound can be stitched up in a straight line.
  • A skin graft may be necessary, which is where skin is borrowed from elsewhere on your body and is sewed in a patch over the wound.
  • The skin surrounding the wound can be rearranged, while maintaining its blood supply, into a skin flap to cover the wound.
At your pre-surgery consultation as well as after the procedure, the doctor will discuss with you the best recovery options for your situation.The surgical risks of Mohs micrographic procedure include bleeding, infection, and scarring. Your doctor will also discuss with you the risks related to the specific locations of the tumor and any other health problems that you may have.Here at our Clackamas, Oregon office we perform Mohs procedures on Wednesdays and Thursdays.

PRE-SURGERY PRECAUTIONS

Two weeks before surgery, you should avoid:
  • Aspirin or any aspirin-containing drug
  • Vitamin E
  • Gingko Biloba
  • Ginseng
  • Feverfew, garlic, or ginger capsules

Two days before surgery, you should avoid:
  • Ibuprofen, Motrin, or Advil
  • Other arthritis drugs
  • Ephedra

Please be sure to inform the doctor about all of the medications you are currently taking.

POST-SURGERY WOUND CARE

If you have stitches, it’s important to keep your bandage dry and clean until they are removed, which is usually five to seven days after the surgery for facial wounds. This means you will have to take special care when showering. Also, to decrease your chances of getting a black eye, we recommend you go home, sit up in a chair, and hold an ice pack on the surgical area on and off (mostly on) until bedtime that night. You should avoid bending over and lifting heavy objects for two to three days, and avoid aerobic exercise for at least two weeks. If you don’t have stitches, you will need to cleanse the wound twice daily. We suggest moistening a cotton-tipped applicator with 0.9 percent saline solution (easily found as contact lens solution or wound irrigation solution) and gently rubbing (not rolling) the wound with it. After cleaning, cut out a circle of a non-stick wound dressing, such as Telfa® or Release™, and cover it with Vaseline®. Then apply it to the wound with paper tape. You don’t need to worry about keeping the wound dry, and exercise is acceptable.

THE FOLLOW-UP

After you have healed from your Mohs surgery, you will need to come in for follow-up appointments:
  • Every three months the first year
  • Every six months the second year
  • And yearly until five years have passed
Once you have skin cancer, you have a 50% chance of new cancer growth within the next three to five years. At these visits we check for recurrence of the cancer, work on prevention, and try to detect any new cancer growths at an earlier stage.

Early detection of cancer greatly increases the chances for successful treatment. Call your local Goodskin office today to schedule an appointment.