"Mohs surgery, also known as chemosurgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. That examination informs the decision for additional tissue removal."Read on to hear about Lindsey's experience at Massachusetts Eye and Ear in Boston. Some photos are fairly graphic, so please stop reading if you are sensitive to blood/swelling. ;)
When I was told I had skin cancer on my face in January of 2016, I was shocked to say the least. I had gone to the dermatologist after noticing a white line on my face that resembled a scar. At first, I thought I had scratched myself while exercising or sleeping and thought nothing of it. However, a few months later, it had not gone away and I hated how it looked. To be completely honest, at that point I thought it was a pimple or blocked pore and I just wanted it off my face since my wedding was quickly approaching. Oh, how wrong I was. Fast forward to the day of my appointment: literally seconds after looking at my face, my dermatologist announced that I "definitely had cancer" and would "need Mohs surgery as soon as possible". Let’s just say his bedside manner wasn’t the best! I left the office ten minutes later in tears, confused and scared, and with a referral to see the best Mohs surgeon at Massachusetts Eye and Ear in Boston, MA. When I got home, I did what everyone told me NOT to do… Googled the hell out of it!
What I learned: Mohs micrographic surgery is the leading treatment today for skin cancer on the face and neck. Mohs surgery is an outpatient procedure, and due to it's unique nature, is performed with local anesthesia so that the patient can remain awake. Until the skin is opened and cells are examined under a microscope, it is really hard to know how far the cancer has spread. My surgeon compared a Basal cell carcinoma spreading to a tree and it's roots. What you see on the surface may be very different than what has spread under the skin. For reference, my wound ended up being about four times larger than the original spot. Mohs surgery is an extremely precise and slow procedure, split up into sections called "levels". Each level involves the surgeon repeatedly removing the smallest piece of skin/cancer cells possible to minimize scarring.
A complete level consists of:
- Local anesthesia is administered
- Horizontal pieces of tissue are cut from the bottom layer of your skin
- The spot is cauterized but left open. Gauze will cover the open wound.
- The surgeon leaves the room and examines the cells under a microscope, testing the margins for cancer cells. A tumor map is drawn with the results.
- A decision is made: are margins clear, or is there still cancer present? If margins are clear, you are done, and the wound can be closed. If the margins are not clear, start back at step A.
Okay - it's timeline/picture time! Here is how my Mohs experience played out:
Here are some additional photos of how it healed over the past year:
Here are the answers to some of the common questions I get: