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 (Mohs Technique, Mohs Surgery)
Summary
Mohs micrographic surgery is a highly specialized procedure for removing certain types of skin cancer. It involves the careful surgical excision of the tumor and surrounding tissue, followed by immediate microscopic examination of the removed tissue to ensure all cancerous cells are eradicated.
Purpose
Mohs surgery is primarily used to treat basal cell carcinoma and squamous cell carcinoma of the skin. The goal is to remove all cancerous tissue while preserving as much healthy tissue as possible. This technique minimizes the risk of recurrence and maximizes cosmetic and functional outcomes.
Indications
- Persistent or recurrent skin cancers.
- Skin cancers located in cosmetically or functionally critical areas (e.g., face, hands).
- Tumors with poorly defined borders.
- Aggressive or large skin cancers.
Preparation
- Patients may be instructed to avoid certain medications that increase bleeding risk (e.g., aspirin, NSAIDs).
- No specific fasting or extensive pre-procedure testing is usually required.
- Patients should plan for someone to drive them home post-procedure.
Procedure Description
- Removal of All Gross Tumor: The visible tumor is surgically excised.
- Surgical Excision of Tissue Specimens: Small sections around the tumor site are carefully removed.
- Mapping and Color Coding of Specimens: Each removed specimen is meticulously mapped and color-coded to correspond with the tumor site.
- Microscopic Examination: The specimens are immediately frozen, cut into thin sections, stained, and examined under a microscope by the surgeon.
- Histopathologic Preparation: Routine stains are used to highlight cancer cells for precise identification.
Tools and Equipment: Surgical instruments, mapping tools, refrigeration equipment, microscope, and histopathologic staining supplies.
Anesthesia: Local anesthesia is typically used to numb the area.
Duration
The procedure can take several hours, depending on the extent of the cancer and the number of stages required to achieve clear margins.
Setting
The surgery is usually performed in an outpatient clinic or a specialized dermatologic surgery center.
Personnel
- Mohs surgeon (typically a dermatologist with specialized training)
- Surgical assistants or nurses
- Histotechnologists or lab technicians
Risks and Complications
- Bleeding
- Infection
- Scarring
- Pain or tenderness at the surgical site
- Rarely, nerve damage or a reaction to anesthesia
Benefits
- High cure rates for skin cancer.
- Minimal removal of healthy tissue, leading to better cosmetic and functional outcomes.
- Immediate confirmation of cancer-free margins during the procedure.
Recovery
- Patients may experience mild pain and swelling; pain management may include over-the-counter pain relievers.
- Bandages and wound care instructions will be provided.
- Stitches may be removed in 1-2 weeks.
- Follow-up visits are crucial to monitor healing and check for recurrence.
Alternatives
- Standard surgical excision
- Radiation therapy
- Cryotherapy
- Topical or systemic medications
Each alternative has its own risk and benefits, but they may not offer the same high cure rate and tissue-sparing advantage as Mohs surgery.
Patient Experience
During the procedure, patients may feel slight pressure but should not experience pain due to local anesthesia. Post-procedure, they may have some discomfort and need to follow wound care instructions. The benefits of Mohs surgery, including its high success rate and tissue preservation, often outweigh temporary discomfort and recovery time.