Purpose:
Mohs surgery is done to treat skin cancers like squamous cell carcinoma and basal cell carcinoma (the two most types of skin cancers), along with some other kinds of skin cancers like melanoma and other rare types of skin cancers.
Mohs surgery is especially preferred in the following types of skin cancers:

• Skin cancers that are large or aggressive
• Skin cancers having borders that are hard to define
• Skin cancers having a high risk of recurrence
• Skin cancers that recur after a previous treatment
• Skin cancers present in areas like the ears, eyes, mouth, nose, hands, feet, and genital area, where preserving healthy tissue is necessary

1. Physical examination: The doctor will examine the various skin changes that may be present, which could indicate skin cancer.

2. Biopsy: The doctor excises (removes) a small portion of the suspected skin tissue and sends it to the laboratory to check for the presence of cancer cells and if present, what type of cancer cells are present.
   

• The procedure is generally performed under local anesthesia (the area of surgery is numbed).
• The raised, visible area of the skin tumor is first removed.
• A thin tissue layer is removed from the site, preserving as much normal, healthy skin as possible.
• The tissue removed is marked for identifying the top, bottom, right, and left sides, which is also marked on the map of the patient.
• The excised tissue is frozen, cut, and stained. This procedure may take about an hour, but the time may vary in different cases.
• The removed tissue layer is examined under a microscope by the surgeon.
• If cancer cells are spotted under the microscope, the doctor identifies its location as per the markings and map, and additional layers of thin tissue are removed only in the area where cancer cells are still remaining.
• Microscopic examination and the removal of additional tissue layers are continued till no more cancer cells are visible under the microscope.
• This procedure allows complete removal of cancer, preserving the surrounding healthy tissue as much as possible.
• The procedure takes a couple of hours to complete.
• It is generally performed as an outpatient procedure, that is, the patient goes home on the same day of the surgery.

The complications of Mohs surgery may include:

• Thick and raised scar tissue formation

• Poor wound healing

• Hematoma (bleeding into the wound from the surrounding tissue)

• Bleeding from the site of the procedure

• Infection

• Pain or tenderness in the area of skin removal

• Itching

• Larger than expected wound creation

• Loss of the function of nerve

• Temporary or permanent numbness in the area of skin removal

• Cutting a muscle nerve while removal, causing weakness in that part of the body

• Regrowth of tumor after the removal of skin cancer

• Functional or cosmetic deformities if the skin cancer is present near structures like the eyes, nose, eyelids, lips, ears, scalp, forehead, fingers, or genital area

• Contact your doctor immediately if you notice any of the above complications after Mohs surgery.

After the complete removal of skin cancer, the resulting wound can be managed in different ways, like:

• The wound may be left to heal on its own.
• The surgeon may close the wound with sutures or stitches
• The wound may be closed using a skin flap (shifting the skin from an adjacent area) or graft (by borrowing tissue from another part of the body)
• A combination of the above approaches
• Reconstructive surgery by a plastic surgeon, in cases of a large tumor
• It is normal to have some swelling, pain, bleeding, or redness after their procedure. These symptoms usually subside on their own in a few days.
• The doctor will instruct you on how to clean the wound.
• The doctor may recommend painkillers and antibiotics to relieve discomfort and prevent the risk of infection.
• Have someone to take you home after the procedure.
• Avoid heavy lifting and strenuous activities after the procedure for a few weeks.
• The results are seen right away after the procedure, and you will most likely go home after the complete removal of skin cancer.
• Regular follow-ups with your doctor, most likely every six months, are recommended to check for any recurrence of cancer.