17313 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 Surgery (also known as Mohs Surgery or Mohs Micrographic Technique)

Summary

Mohs Micrographic Surgery is a specialized surgical technique used to treat skin cancer. It involves the systematic removal of the cancerous tissue layer by layer, examining each layer under a microscope until only cancer-free tissue remains. This method ensures complete cancer removal while preserving as much healthy tissue as possible.

Purpose

Mohs Surgery is primarily used to treat skin cancers, such as basal cell carcinoma and squamous cell carcinoma. The goal is to completely remove the cancer while minimizing damage to surrounding healthy tissue, particularly in areas where cosmetic or functional preservation is essential, such as the face or hands.

Indications

• Diagnosed skin cancer that is large, aggressive, or has indistinct borders.
• Recurring skin cancer, or cancer located in areas with high risk of recurrence.
• Skin cancer found in cosmetically or functionally sensitive areas where tissue conservation is paramount.
• Patient criteria include being in generally good health to undergo the procedure and having the ability to tolerate local anesthesia.

Preparation

• Patients may be advised to avoid certain medications, such as blood thinners, for a period before the surgery.
• A thorough skin examination and possibly imaging tests to map the extent of the cancer.
• Pre-procedure consultation to discuss medical history, allergies, and to provide instructions.

Procedure Description

1. Removal of Gross Tumor: The visible portion of the tumor is removed.
2. Surgical Excision of Tissue Specimens: Thin layers of tissue are progressively removed around and beneath the tumor site.
3. Mapping and Color Coding: Each tissue sample is mapped to its specific location on the body and color-coded with special dyes for orientation.
4. Microscopic Examination: Each removed tissue layer is microscopically examined by the surgeon to check for cancer cells. If cancer cells are present, another layer is removed from the exact location where cancer cells remain.
5. Histopathologic Preparation: Tissue specimens are prepared and stained with routine stains for detailed microscopic examination.
6. This process is repeated until no more cancer cells are detected in the tissue samples.

Duration

The procedure typically takes several hours, depending on the size and location of the tumor and the number of layers that must be removed.

Setting

Mohs Surgery is performed in an outpatient clinic or surgical center equipped with an onsite laboratory for immediate microscopic examination.

Personnel

• A specially trained Mohs surgeon (a dermatologist with specialized training in this technique).
• Nurses or medical assistants.
• Histotechnicians for preparing tissue slides.
• Anesthesiologists or nurse anesthetists if sedation beyond local anesthesia is needed.

Risks and Complications

• Common risks: Bleeding, infection, and scarring.
• Rare risks: Nerve damage, prolonged pain, or allergic reactions. Complications are usually managed through appropriate post-operative care and monitoring.

Benefits

• High cure rates, especially for recurrent and difficult-to-treat skin cancers.
• Minimal removal of healthy tissue, leading to better cosmetic outcomes.
• Immediate verification of cancer-free tissue reduces the need for future surgeries.

Recovery

• Patients can usually go home the same day.
• Instructions may include wound care, medication for pain, and infection prevention.
• Avoiding strenuous activity until the site is sufficiently healed.
• Follow-up appointments to monitor healing and ensure no cancer recurrence.

Alternatives

• Traditional Surgical Excision: Wider margin of healthy tissue is removed but doesn't provide immediate microscopic evaluation.
• Radiation Therapy: Used for patients who are not surgical candidates; however, it may not be as effective for certain types of skin cancer.
• Topical Chemotherapy: Best suited for superficial skin cancers but may not be effective for deeper or larger tumors.
• Each alternative has its own benefits and limitations, generally concerning cure rate, tissue preservation, and cosmetic outcome.

Patient Experience

• During the Procedure: Patients will be awake, and the area will be numbed with local anesthesia. Some may feel pressure or minor discomfort.
• After the Procedure: There may be mild pain or swelling, manageable with prescribed pain relief. Detailed post-op care instructions will help ensure proper healing and minimize complications.

Overall, Mohs Surgery is a precise and effective treatment aimed at completely removing skin cancer while preserving healthy tissue and minimizing scarring.