About The Procedure

How is the procedure performed?

A team of medical personnel that includes Dr. Echt, nurses and histotechnicians performs Mohs surgery. Dr. Echt has subspecialty (fellowship) surgical training in the technique and is recognized by the American Society of Mohs Micrographic Surgery and Cutaneous Oncology. The nurse is an important part of the team who helps answer questions and comforts the patient. A technician performs the important task of preparing the tissue slides, which are examined under a microscope by Dr. Echt.

The surgery is performed as follows:

  1. The skin suspected of cancer is treated with a local anesthetic so there is no pain in the area.
  2. To remove most of the visible skin cancer, the tumor is scraped using a sharp instrument called a curette.
  3. A disc-shaped piece of tissue then is removed with a scalpel around and underneath the scraped skin and carefully divided into pieces that will fit on a microscope slide.
  4. The edges are marked with colored dyes; a careful map or diagram of the tissue is made; and the tissue is submitted for frozen section processing.
  5. Most bleeding is controlled using pressure and electrocautery, although occasionally a small blood vessel is encountered that must be tied using suture material.
  6. A pressure dressing is then applied, and the patient is asked to wait while the slides are being processed.
  7. Dr. Echt then will examine the slides under the microscope and be able to tell if any tumor is still present.
  8. If cancer cells remain, they can be located by referring to the map. Another section of tissue is then removed, and the procedure is repeated until the physician is satisfied that the entire base and sides of the wound have no cancer cells remaining.

As well as ensuring total removal of the cancer, this process preserves as much normal, healthy surrounding skin as possible.

The removal and processing of each layer of tissue takes approximately one hour. Only 20 to 30 minutes of that are spent in the actual surgical procedure. The remaining time is required for slide preparation and interpretation. Therefore, by beginning early in the morning, Mohs surgery is generally finished in one day. Sometimes, however, a tumor may be extensive enough to necessitate continuing surgery a second day.

At the end of Mohs surgery, you will have a surgical wound. Several reconstruction options will be discussed to provide the best possible cosmetic results. Reconstruction is usually performed on the same day.