Outlined Procedure

Steps to treating skin cancer with Mohs surgery

Outline the visible tumor or biopsy scar.

1. Infiltrate the site with a local anesthetic.
2. Debulk – remove the obvious tumor or scar tissue.
3. Make a narrow incision circumferentially around the cancer. Make small marks on the skin to help maintain orientation.
4. Remove the area of tissue in a thin layer.
5. Divide the specimen and code each portion with different color dyes.
6. Process the specimen, place on slides, stain, and examine it microscopically.
7. Mark the areas positive for cancer.
8. Bring the patient back to the operating room.
9. Make an incision around the positive area. Remove this tissue and examine it microscopically.
10. Repeat steps 7, 8, 9, and 10 until the section of tissue is negative for any residual cancer cells. At this point, the removal of the cancer is considered complete. Attention now turns to repairing the wound.
11. Evaluate the wound and choose the method of repair. Allow superficial wounds to heal on their own, but most wounds are sutured.
12. Remove small triangles of skin from either end of the oval wound and suture the wound edges together. The eversion or bumpiness of the wound is temporary.
13. Observe after nine months. There may be a scar, but it will be subtle.