17312 Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (

Name of the Procedure:

Mohs Micrographic Technique (also known as Mohs Surgery, Mohs Micrographic Surgery)

Summary

Mohs micrographic technique is a precise surgical method used to treat skin cancer. It involves the step-by-step removal and examination of the cancerous tissue until no cancer cells remain. The procedure ensures complete removal of the tumor while preserving as much healthy tissue as possible.

Purpose

Medical Condition: Skin cancer, including basal cell carcinoma, squamous cell carcinoma, and certain melanomas. Goals:

• Complete removal of the cancerous tissue
• Minimize damage to surrounding healthy tissue
• Reduce the likelihood of recurrence

Indications

• Presence of skin cancer, confirmed through biopsy
• Tumors with indistinct borders
• Recurrent skin cancers
• Cancers located in cosmetically and functionally important areas (e.g., face, hands)

Preparation

• Patients may be advised to stop certain medications (e.g., blood thinners) as per doctor's instructions.
• Avoid smoking and alcohol before the procedure.
• Fasting is not typically required.
• Routine pre-operative assessments to understand patient’s health condition.

Procedure Description

1. Anesthesia: Local anesthesia is administered to numb the area.
2. Removal of Gross Tumor: Visible portion of the tumor is surgically removed.
3. Tissue Specimen Excision: Layers of tissue are systematically removed one at a time.
4. Mapping and Color Coding: Each tissue specimen is mapped and color-coded to pinpoint its exact location on the skin.
5. Microscopic Examination: The surgeon examines each tissue layer under a microscope to detect cancer cells.
6. Histopathologic Preparation: Tissue specimens are processed and stained with routine stains to enhance visibility of cancer cells.
7. Repeat Procedure: Steps 3 to 6 are repeated until no cancer cells are detected in the tissue samples.

Duration

The procedure can take several hours, depending on the extent of the tumor.

Setting

The procedure is typically performed in an outpatient clinic or a specialized surgical center.

Personnel

• Mohs surgeon (usually a dermatologist with specialized training)
• Surgical assistants
• Nurses
• Technicians for preparing and examining tissue specimens

Risks and Complications

• Common: Bleeding, infection, pain at the surgical site
• Rare: Nerve damage, poor wound healing, scarring Complications can generally be managed with appropriate medical care.

Benefits

• High cure rates for skin cancer
• Minimal removal of healthy tissue
• Reduced risk of cancer recurrence
• Preservation of cosmetic and functional outcomes

Recovery

• Post-procedure care includes wound care instructions, pain management, and possible antibiotic use.
• Recovery time varies; typically, patients can resume normal activities within a week.
• Follow-up appointments to monitor healing and check for any recurrence.

Alternatives

• Traditional surgical excision
• Radiation therapy
• Cryotherapy (freezing)
• Topical medications Each alternative varies in effectiveness, recovery time, and potential for cosmetic outcomes.

Patient Experience

• During the procedure, the patient will be awake but should not feel pain due to local anesthesia.
• Minor discomfort or pressure may be felt.
• After the procedure, pain can be managed with over-the-counter pain medications.
• Some swelling and bruising are normal and will resolve with time.
• Patients should follow specific care instructions to ensure proper healing and minimize complications.