In most instances, however, the Mohs surgeon will repair the wound immediately after obtaining clear margins. In some cases, your Mohs surgeon may coordinate the repair of your wound with another specialist such as a plastic surgeon, oculoplastic surgeon or hand surgeon. In some cases, a wound may need reconstruction with a skin flap, where neighboring tissue is moved into the wound, or possibly a skin graft. Once the site is clear of all cancer cells, the wound may be left open to heal or the surgeon may close it with stitches. This entire process is repeated as many times as needed until there are no more cancer cells. Then, while you wait, the lab work begins again. Step 5: Second layer removalīack in the operating room, the surgeon injects more anesthesia if needed and removes another layer of skin, precisely where the cancer cells remain, based on the map. The physician then lets you know whether you need another layer of tissue removed. Using a microscope, the surgeon examines all the edges and underside of the tissue on the slides and, if any cancer cells remain, marks their location on the map. The slices are placed on microscope slides, stained and covered. In the lab, a technician freezes the divided tissue, then cuts very thin horizontal slices like a layer cake. The surgeon cuts the tissue into sections, color codes them with dyes and draws a map of the surgical site. Your wound is bandaged temporarily and you can relax while the lab work begins. The lab analysis, which comes next, will determine that. Some skin cancers may be “the tip of the iceberg,” meaning they have roots or extensions that aren’t visible from the surface. Using a scalpel, the surgeon removes a thin layer of visible cancerous tissue. The surgeon then injects a local anesthesia, which numbs the area completely. If your skin cancer is on your face, that may mean you can’t see what’s happening, but the doctor talks you through it. A surgical drape is placed over the area. The doctor positions you for best access, which may mean sitting up or lying down. The Mohs surgeon examines the spot where you had your biopsy and may mark it with a pen for reference. Step 1: Examination and prepĭepending on the location of your skin cancer, you may be able to wear your street clothes, or you may need to put on a hospital gown. The doctor repeats this process until no cancer cells remain. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. The procedure is done in stages, all in one visit, while the patient waits between each stage.
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