Understanding Skin Cancer and Mohs Surgery

Mike: My name is Mike. I was told that I had skin cancer a month ago.

Janine: I'm Janine. I was told that I have skin cancer a month ago.

Mike: I knew something wasn't right when I had a pimple that would come and go and finally began to bleed. I went to a dermatologist near home and had a biopsy. I was given a call and told that I have a basal cell carcinoma.

Janine: I was called with a diagnosis of basal cell carcinoma.

Doctor: Hi Mike.

Mike: Hi Doctor.

Doctor: How are you doing?

Mike: I'm fine. Thank you.

Doctor: Well, I got your pathology report, and your biopsy showed basal cell carcinoma.

Mike: What does that mean now?

Doctor: There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinoma and squamous cell carcinoma are considered non-melanoma skin cancers and mainly only affect the skin and do not turn into melanoma.

Mike: How did I get skin cancer?

Doctor: Well, usually the causes are light skin color, light hair, blond or red, light-colored eyes, skin that tends to burn or freckle easily, sun exposure over many years, or genes.

Mike: What will happen if I don't treat my skin cancer?

Doctor: Well, that's a great question. If left untreated, the basal cell carcinoma continues to get larger with time, eventually destroys surrounding tissue, and turns into a wound that never heals.

Mike: Honestly, I felt nervous. I wasn't sure if I wanted to have a surgery, but I knew I didn't want to allow the cancer to grow. I needed to learn more to feel comfortable.

Mike (to the Doctor): I'd like to know more about treating my skin cancer. Can you tell me about Mohs surgery?

Doctor: Well, there are many ways to treat skin cancer. In your case, Mohs surgery would be the most effective.

Voice Over: Skin cancers may have microscopic roots that extend beyond the visible portion. In Mohs surgery, the first layer is removed around the visible cancer. The layer is divided into sections, and the peripheral edge and depth are examined microscopically.

Voice Over: If any cancer cells are present at the margin, they are mapped so that the second layer only removes cancer and not any additional healthy tissue. Mohs surgery has the highest cure rate.

Mike: At this point, I was leaning toward having the surgery. I had concerns about whether I would be awake, whether I would be in pain, and how much of a scar that I would have.

Voice Over: Mohs surgery is done in an outpatient setting, which means you are awake the entire time, but the surgery site is numbed with an injection of local anesthesia.

Doctor: Bleeding, infection, numbness, and recurrence are small but potential risks of Mohs surgery. Commonly, patients experience bruising, swelling, and mild pain. Although a scar is unavoidable, we use techniques to minimize the scar's appearance.

Mike: So, I made a decision to go ahead with the surgery.

Janine: So, I decided to go ahead with the surgery.

Nurse: Hi, I'm Phyllis, one of the nurses here with the Mohs team. How are you doing?

Mike: Hi. Fine, thank you.

Nurse: Did you eat your breakfast this morning and take your medication?

Mike: I did. And I cleared my schedule and packed a bunch.

Nurse: Good. We'll review your medical information, and the doctor will be right in.

Mike: Thank you.

Voice Over: On the day of surgery, you may eat, drink, and take medications as usual, unless directed otherwise. Plan to be at the office for a full day, and bring reading materials and snacks, as there will be downtime while the tissue processes, about 60 to 90 minutes for each layer.

Voice Over: On the day of surgery, the patient is prepped by the clinical team. Local anesthetic injection is used to numb the skin cancer area, and the first layer is removed.

Voice Over: The tissue is brought to the lab, where the specimen is prepared by the histotech. During this time, the patient waits in a waiting room.

Voice Over: Once the slides are prepared, the doctor analyzes the tissue under the microscope and maps any remaining cancer cells.

Voice Over: In this case, the basal cell carcinoma will be removed in the second layer of Mohs surgery.

Mike: For me, it was only two layers for the doctor to remove the cancer completely. At that point, the doctor looked at the wound, gave me some options to minimize the scar. We decided to use stitches.

Doctor: Once the skin cancer is clear, the wound will be assessed. Repair options will be discussed and depend on the size, location, and depth of the wound.

Doctor: Options include allowing the wound to heal naturally, closing the wound side to side with stitches, a flap where nearby skin is moved into the wound, or a skin graft, where skin from another area is patched into the wound. Surgical scars gradually improve with time.

Voice Over: At the end of the day, the bandage is applied to the surgical site, and the nurse will discuss wound care instructions with you. Following the instructions carefully will optimize healing for a favorable scar.

Janine: Overall, I had a good experience with Mohs surgery.

Mike: Overall, I had a good experience with Mohs surgery.

Janine: The team made me feel very comfortable, and I'm very happy with the results.

Mike: It was a lot better than I anticipated it would be. My family reminded me to follow directions exactly for about two weeks. The team made me feel very comfortable, and I feel very good about the outcome.