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) (
CPT4 code
Name of the Procedure
Mohs Micrographic Surgery
Common Names: Mohs Surgery, Mohs Micrographic Technique
Summary
Mohs micrographic surgery is a precise surgical technique used to treat skin cancer. By removing thin layers of cancer-containing skin and examining each under a microscope until only cancer-free tissue remains, it ensures the complete removal of the cancer while conserving as much healthy tissue as possible.
Purpose
Medical Condition Addressed: Skin cancer, including basal cell carcinoma, squamous cell carcinoma, and some melanomas.
Goals/Outcomes: To completely remove the cancerous tissue while preserving as much healthy skin as possible. This minimizes both the potential for cancer recurrence and the size of the surgical scar.
Indications
Symptoms/Conditions:
- Non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma)
- Certain cases of melanoma
- Recurrent or aggressive skin cancers
Cancers located in cosmetically sensitive or functionally critical areas (e.g., face, hands, genitals)
Patient Criteria:
- Individuals diagnosed with skin cancer
- Patients requiring precise excision to minimize scarring
Preparation
Pre-Procedure Instructions:
- Fast as directed if sedation is to be used
- Avoid certain medications (e.g., blood thinners) as advised
- Ensure all pre-procedure diagnostic tests (e.g., biopsy results) are completed and available
Procedure Description
- Removal of Gross Tumor: The visible portion of the tumor is surgically excised.
- Tissue Specimens: Additional tissue around the tumor site is removed in thin layers.
- Mapping: The removed tissue layers are mapped, ensuring precise orientation with the surgical site.
- Color Coding: The specimens are color-coded to assist in microscopic examination.
- Microscopic Examination: The surgeon examines the tissue slices under a microscope to identify any remaining cancer cells.
- Histopathologic Preparation: Each specimen undergoes preparation, including routine staining with specific dyes, to highlight cellular structures.
- Repeat as Necessary: Steps 2-6 are repeated until no cancerous cells are detected in the tissue slices.
Tools and Equipment: Surgical instruments, microscope, staining solutions, mapping materials.
Anesthesia: Local anesthesia is typically used to numb the surgical area.
Duration
The procedure typically takes several hours, depending on how many layers need to be examined and removed.
Setting
Performed in an outpatient clinic or surgical center specialized for dermatologic procedures.
Personnel
- Surgeon: A dermatologist specialized in Mohs micrographic surgery.
- Nurses: Assist with patient care and intraoperative support.
- Histotechnician: Prepares tissue specimens for microscopic examination.
- Anesthesiologist (if sedation is used): Manages sedation and patient comfort.
Risks and Complications
Common Risks:
- Bleeding
- Infection
- Pain at the surgery site
Rare Risks:
- Nerve damage
- Significant scarring or cosmetic dissatisfaction
Management: Risks are managed with appropriate antibiotics, pain management, and careful surgical technique.
Benefits
Expected Benefits:
- High cure rate for skin cancer
- Minimal removal of healthy tissue
- Reduced risk of recurrence
Timeline for Benefits: The benefits of cancer removal are immediate; however, optimal healing of the surgical site may take several weeks to months.
Recovery
Post-Procedure Care:
- Keep the surgical site clean and dry.
- Follow wound care instructions provided by the surgeon.
- Take prescribed medications as directed (e.g., pain relievers, antibiotics).
Recovery Time:
- Initial healing typically takes 1-2 weeks.
- Full recovery, including complete healing of the surgical site, may take several months.
Restrictions/Follow-Up:
- Avoid strenuous activities that may stress the surgical area.
- Attend follow-up appointments to monitor healing and for cancer recurrence surveillance.
Alternatives
Other Treatment Options:
- Excisional surgery
- Radiation therapy
Topical treatments (for early, superficial cancers)
Pros and Cons of Alternatives:
- Excisional Surgery: Less specialized but effective; may result in more scarring.
- Radiation Therapy: Non-surgical option but with potential side effects and typically requires multiple sessions.
- Topical Treatments: Non-invasive but less effective for deeper or aggressive tumors.
Patient Experience
During the Procedure:
- The patient remains awake and may feel pressure or minor discomfort.
- Local anesthesia will prevent pain.
Post-Procedure:
- Expected to feel some pain or tenderness at the surgery site.
- Pain can be managed with prescribed pain relievers.
- Swelling and minor bleeding may occur initially but should subside in a few days.