Any experience with MOHS surgery?

[Simba's Mom]

DH has a basal cell carcinoma on his nose. Doctor said MOHS surgery would mean less scarring, would preserve more tissue, but DH would have to go to a specialist. The only bad part is that the nearest specialist is 4 1/2 hours away. DH says "Hey, I'm 62 yo, not a male model, is the MOHS surgery really that much better looking to justify it?" I was just wondering, if anyone has had the MOHS surgery (That's where they shave very thin layers of skin and it takes a long time as they biopsy each layer), does it really mean very little scarring?

 

[lorimay]

Sorry to hear about your husbands diagnosis.
My husband has had at least 20 different bouts with basal cell in the last 9 years.
Just last week he had 7 removed from his legs, arms and back. Yes, he was a sun worshipper in his younger days.
He has always done the regular scraping on them. I have never heard of this surgery option.
Most he has require no stitches.
A few he has had 3 or 4 stitches.
He had one removed last year on his forehead. I was worried he would be scarred because they had to cut for this one. But you can hardly see it, its just a tiny little bump.

My mom had one removed by her eye, the doctor did a great job on her as well. You can hardly see her scar very minimal.

I wish your husband good luck with his surgery.
Noses are a much more sensitive area.

 

[SpecialK]

My father had a MOHS procedure for a lesion on his lip. It turned out to be deep enough that there was some permanent numbness, but there was absolutely no scarring. You could not tell by looking at him that he had ever had the surgery.

 

[Geoff_M]

I had a MOHS procedure done on my chin last September. It was a "pimple" half way between by lip and the point of my chin that wouldn't heal that turned out to be a carcinoma. They ended up removing a hunk of my chin equivalent in size and depth to what you'd get if you sliced a piece off a golf ball that was the diameter of a quarter. They pinched the round opening shut and sewed it up vertically. The 16 stitches ran from just under my lip to the point of my chin. I looked like "Frankenstein" at first, but now the scar is only really noticeable when the light hits it right or I use my tongue to stretch out the skin on my chin from the inside. Other than a little residual "tightness" due to internal scar tissue, it's fine.

 

[redbirdgrad]

I had it done September 2012, had a pin size spot on my nose for a couple of weeks that wouldn't heal, had my regular checkup with my dermatologist and pointed it out - he looks, says basal cell - you need to see a plastic surgeon for MOHS. I said just dig it out - he said nope, there is a procedure. I went and had it done (at the hospital), knocked out, took 30 minutes, I was at the hospital total less than 4 hours. I had about 18 stiches or so and yes my first look at it was WOW thats a hole on my nose - but sure enough the healing happened quick and 6 months later you couldn't even tell.

 

[minkydog]

I just had two basal cell cancers removed from the right side of my nose in September. They were located in the folds of my nose, where the skin is very thin. The doctor had to do it in two procedures because it was such a delicate place.

I have no regrets AT ALL. By doing the MOHS, my doctor was able to see immediately if he got it all; he was able to go right back in and get a little more from one of them, rather than risking having it start growing again. He did a small skin graft on each site with about 10 tiny stitches on each one. The end result is very good. There is some scarring but the way it's positioned, it is not very noticeable. In places it's still a little bumpy, but that will resolve within the next 6 months, I'm sure. And if it doesn't, I can have a little laser on it to smooth it out.

I would absolutely drive 4-1/2 hours to get MOHS done. It only took about 1-1/2 hours to get it all out and it gave me great piece of mind.

 

[asta]

I had MOHS surgery on my upper arm. There is a small amount of scarring but the cancer had been on my arm for several years. (lesson learned: don't rely on what your doctor thinks it is, always ask for a biopsy if you suspect something). I don't think scarring is the main issue. The benefit of MOHS surgery is that you know if all of the cancerous cells are gone.

 

[lorimay]

Wow , this is new information to me.

I just want to ask, is this procedure always done under anesthesia?
Does the dermatologist or a general surgeon perform the procedure?

Thanks.
Lori

 

[shortbun]

My MIL had it on the tip of her nose. She has a flat spot but you have to look for it. No scar. I, on the other hand, had a basal cell removed from my face my incision and although they tried to cut on my normal lines, I can see it. I'd go for the MOHS.

 

[aprilgail2]

Wow , this is new information to me. I just want to ask, is this procedure always done under anesthesia? Does the dermatologist or a general surgeon perform the procedure? Thanks. Lori

I have taken my mom for at least 8 mohs procedures and it has never been done under anesthesia. They just numb the area and cut, you go sit in waiting room while they check to see if boarders are clear- they you go back in and they cut some more, go to waiting room etc until all are clear. One time it could be one or two cuts, another time 4 or 5.

 

[pampam]

A year and a half ago I was diagnosed with basel cell carcinoma between my eye and my nose. In all of Canada there were only 7 hospitals that would do MOHS, and my hospital was not one of them. However, the pathologist had worked in one of those 7 hospitals and was very familiar with it, so this is what we did. My surgeon was familiar with Mohs but did not have the skills to do a layer of skin at a time, so he just removed minute particles of the cancer at a time and then they would send it off to the pathologist for an assessment. He would wait for the report and then remove more skin if necessary.

I know they did this, because I woke up and realized I was still in the operating room. I wasn't sure if I should sit up, say something or what to do. (I was groggy and relaxed so I wasn't too concerned.) It was very quiet, and I wasn't sure if I was alone, or what was going on. Then I heard someone enter the room and say "It's all clear toward the eye, but more needs to be taken away toward the nose". The surgeon said to me "We are going to freeze you some more" and I said to him "Make sure you give me some more of this", and I pointed to my IV. "Oh yes" he said, and I was put out again. When they wheeled me out of the O.R. the jostling woke me up again, and the Dr told me I was cancer free. I went back to sleep, and when I was fully awake, the Surgeon again came and told me I ws cancer free. It was a good feeling.

It was a good operation, and I don't have a noticable scar at all.

 

[Pembo]

Just had Mohs Surgery in September on my neck. I went to a specialist and it was very easy. Local anesthetic and I was out of there in 2 hours. I only needed one time of scraping. She got it all.

My scar looks great already. The only complication was I'm allergic to the latex in the tape and I was very itchy. I couldn't stand the steri strips. But the surgeon had me remove them and keep the wound moist with Vaseline. It worked out fine.

I would recommend it!

My coworker had a basal cell on her chest. The dermatologist never mentioned Mohs, she just shaved it off. She has a very unattractive scar and doesn't know if they got it all. Also the same dermatologist didn't recommend bi-yearly skin checks either.

 

[minkydog]

Just had Mohs Surgery in September on my neck. I went to a specialist and it was very easy. Local anesthetic and I was out of there in 2 hours. I only needed one time of scraping. She got it all.

My scar looks great already. The only complication was I'm allergic to the latex in the tape and I was very itchy. I couldn't stand the steri strips. But the surgeon had me remove them and keep the wound moist with Vaseline. It worked out fine.

I would recommend it!

My coworker had a basal cell on her chest. The dermatologist never mentioned Mohs, she just shaved it off. She has a very unattractive scar and doesn't know if they got it all. Also the same dermatologist didn't recommend bi-yearly skin checks either.

I had one on my calf that was shaved off and it has always looked ugly. Mohs is the way to go. Mine were done with local anesthesia. I imagine if they had been large and invasive the doctor might have chosen to do them under deep sedation. Honestly, the worst part was getting the local. Shots to your nose hurt, but that pain doesn't doesn't last long. Afterward it hurt a bit, but Tylenol pretty much took care of that. My itty bitty scars look good!

 

[Geoff_M]

In all of Canada there were only 7 hospitals that would do MOHS, and my hospital was not one of them. However, the pathologist had worked in one of those 7 hospitals and was very familiar with it, so this is what we did. My surgeon was familiar with Mohs but did not have the skills to do a layer of skin at a time, so he just removed minute particles of the cancer at a time and then they would send it off to the pathologist for an assessment.

Wow, that's bizarre... mine was done in my local dermatologist's office using local anesthesia only. He also examined the tissue slices himself to confirm that he "got it all".

 

[Simba's Mom]

Thanks everyone. It sounds as if the MOHS surgery is a little more reliable (is that the right word?) Like I said, it's not available around here, so DH will have to travel, but it IS in many parts of the country. Sounds like it's probably worth it though.

 

[aprilgail2]

A year and a half ago I was diagnosed with basel cell carcinoma between my eye and my nose. In all of Canada there were only 7 hospitals that would do MOHS, and my hospital was not one of them. However, the pathologist had worked in one of those 7 hospitals and was very familiar with it, so this is what we did. My surgeon was familiar with Mohs but did not have the skills to do a layer of skin at a time, so he just removed minute particles of the cancer at a time and then they would send it off to the pathologist for an assessment. He would wait for the report and then remove more skin if necessary. I know they did this, because I woke up and realized I was still in the operating room. I wasn't sure if I should sit up, say something or what to do. (I was groggy and relaxed so I wasn't too concerned.) It was very quiet, and I wasn't sure if I was alone, or what was going on. Then I heard someone enter the room and say "It's all clear toward the eye, but more needs to be taken away toward the nose". The surgeon said to me "We are going to freeze you some more" and I said to him "Make sure you give me some more of this", and I pointed to my IV. "Oh yes" he said, and I was put out again. When they wheeled me out of the O.R. the jostling woke me up again, and the Dr told me I was cancer free. I went back to sleep, and when I was fully awake, the Surgeon again came and told me I ws cancer free. It was a good feeling. It was a good operation, and I don't have a noticable scar at all.

Operating room just for MOHS?? Wow that a bit of overkill. Here there are plenty of places that do it and none are hospitals. They do it right in plenty of dermatologist offices or even have places that just do MOHS - they are just rooms like regular dr office rooms, give you a local and you are fine. I have never heard of bring knocked out for it or having to go to a hospital!

 

[LukenDC]

I had MOHS surgery in February and the procedure left a scar so thin and faint that no one can see it and I can only see it if I look closely in a mirror under bright light. Other types of skin cancer surgery can be very disfiguring, so I would highly recommend that your husband have the MOHS procedure. There is not much tissue on the nose to begin with, so anything that conserves healthy tissue is a plus. Yes, he is 62, but he hopefully has many years ahead of him and it would be a shame to spend many years with disfiguration that was preventable.

 

[pampam]

Operating room just for MOHS?? Wow that a bit of overkill. Here there are plenty of places that do it and none are hospitals. They do it right in plenty of dermatologist offices or even have places that just do MOHS - they are just rooms like regular dr office rooms, give you a local and you are fine. I have never heard of bring knocked out for it or having to go to a hospital!

How do assess the tissue before closing the wound, knowing they got all the cancer? Since MOHs is such a precise type of surgery, and requires a pathologist I'm surprised it is done in places that are not hospitals.

 

[Pembo]

How do assess the tissue before closing the wound, knowing they got all the cancer? Since MOHs is such a precise type of surgery, and requires a pathologist I'm surprised it is done in places that are not hospitals.

I had mine in an office where they do Mohs all day long. The surgeon scraped away tissue, put a bandage on me and sent me to the waiting room. She game the sample to the lab, they looked at it under the microscope and deemed it all clear. I came back in to the room and I had more numbing meds, the surgeon stitched me up and I was done. Like others have said, they use a local anesthetic. They wear gowns and masks and all. Very sterile.

 

[minkydog]

How do assess the tissue before closing the wound, knowing they got all the cancer? Since MOHs is such a precise type of surgery, and requires a pathologist I'm surprised it is done in places that are not hospitals.

MOHS do NOT require a pathologist! A well-trained dermatologist is perfectly capable of detecting skin cancers in the biopsied skin. They have to have specialized equipment to cut the biopsy into many slivers, and a microscope capable of looking at those slivers. He can tell if he got it all and left a clear margin or if he needs to go back and get a little more.

Now there may be circumstances in which someone would need this done in a hospital. If the cancer is large & invasive and will require a large skin graft to close, then doing it in the hospital operating room might be wise. But most skin cancers are fairly small and can easily be managed with MOHS surgery in the doctor's office.