The Mohs Surgery Process
Step 1: The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur.
Step 2: The visible tumor is surgically removed.
Step 3: A layer of skin is removed and divided into sections. Dr. Carroll makes reference marks on the skin to show the source of these sections. A map of the surgical site is then drawn.
Step 4: The undersurface and edges of each section are microscopically examined for evidence of remaining cancer.
Step 5: If cancer cells are found under the microscope, Dr. Carroll marks their location onto the "map" and returns to the patient to remove another layer of skin - but only from precisely where the cancer cells remain.
Step 6: The removal process stops when there is no longer any evidence of cancer remaining in the surgical site. Because Mohs surgey removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.
While treatment of the skin cancer is of primary concern, reconstruction of the treated area is also important.
Dr. Carroll has specialized reconstructive surgery training for repairing the wound. After Dr. Carroll is confident that all of the cancer has been removed, together with the patient, he then determines how the wound will be repaired.
Small, simple wounds may be allowed to heal by themselves (a process known as secondary-intention healing). Slightly larger wounds may be closed with stitches in a side-to-side fashion. Larger or more complicated wounds may require a skin graft from another area of the body or a flap, which closes the defect with skin adjacent to the wound.
On rare occasions, the patient may be referred to another EVMS reconstructive surgical specialist.