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 (MMS)
Summary
Mohs micrographic surgery is a highly effective procedure for removing skin cancer. During the procedure, the surgeon meticulously removes all visible tumor tissue and examines the margins under a microscope, ensuring complete cancer removal while preserving as much healthy tissue as possible. This involves surgical excision of tissue specimens, careful mapping and color-coding, microscopic examination, and histopathologic preparation with routine stains.
Purpose
Mohs surgery is primarily used to treat skin cancer, especially basal cell carcinoma and squamous cell carcinoma. The goal is to completely remove the cancer while sparing as much healthy tissue as possible, reducing the likelihood of requiring additional treatments and minimizing scarring.
Indications
- Presence of skin cancer, particularly on areas where tissue preservation is crucial (e.g., face, ears, hands).
- Recurring or large cancers.
- Cancer with indistinct borders.
- Tumors in scar tissue.
- High-risk cancer types.
Preparation
- Patients should follow specific pre-surgery instructions provided by their doctor, which may include medication adjustments.
- No fasting generally required, but specifics depend on the patient's overall health.
- Pre-procedure consultation and assessments, such as a detailed medical history and physical exam.
Procedure Description
- Initial Examination: The dermatologist/surgeon examines the skin cancer.
- Anesthesia: Local anesthesia is administered to numb the treatment area.
- Removal of Visible Tumor: The surgeon removes the visible portion of the tumor.
- Mapping and Color Coding: The removed tissue is mapped and color-coded to track its original position on the patient.
- Microscopic Examination: The tissue specimens are processed, and the surgeon examines them under a microscope.
- Histopathologic Preparation: Routine stains are used to prepare the specimens for detailed examination.
- Additional Tissue Removal (if necessary): If cancer cells are detected at the margins, additional layers are removed and examined until no cancer cells remain.
Duration
The procedure typically takes several hours due to the detailed microscopic analysis required between each tissue removal and examination step.
Setting
Mohs surgery is usually performed in a dermatologic surgery clinic or outpatient surgical center equipped with laboratory facilities.
Personnel
- Dermatologic Surgeon (specially trained in Mohs surgery)
- Surgical Nurse
- Histotechnician (prepares microscopic slides)
Risks and Complications
- Bleeding
- Infection
- Scarring
- Pain at the surgery site
- Rarely, nerve damage
Benefits
- High cure rate for skin cancer.
- Maximal healthy tissue preservation.
- Minimized scarring.
- Reduced need for additional treatments.
Recovery
- Patients may experience tenderness, swelling, and minor pain post-procedure.
- Care instructions typically include keeping the wound clean and dry, application of prescribed ointments, and avoiding strenuous activities.
- Follow-up visits to monitor healing and ensure complete cancer removal.
- Recovery time varies, but most patients resume normal activities within a few days to a week.
Alternatives
- Standard surgical excision
- Radiation therapy
- Topical chemotherapy
- Cryotherapy (freezing the cancer cells)
- Each alternative has different success rates, recovery times, and potential for tissue preservation.
Patient Experience
- Patients are awake during the procedure due to local anesthesia, feeling minimal to no pain during tissue removal.
- The process may be lengthy with waiting periods between surgical stages; patients should plan for a full day's procedure.
- Post-operative pain relief typically managed with over-the-counter pain medication.