Dr. Leon Gilead

The Advantages of Mohs Surgery in Removing Cancerous Growths Some skin cancers may appear deceptively small, but they are actually deeper within the skin than what is visible on the surface. These growths can have “roots” extending into the deeper layers of the skin or along blood vessels, nerves, or scar tissue. Additionally, recurrent growths after partial removal can send out deeper extensions below the scar tissue formed after the previous surgery. One of the vulnerabilities of skin cancers lies in the fact that they are continuous growths originating from a single cell, with all their parts interconnected. Mohs surgery leverages this vulnerability and is specifically designed to meticulously track and remove these cancerous “roots” until complete removal, thereby preventing further recurrence of the growth.

The surgeon must verify that there is indeed a need to analyze the lesion using the Mohs method. During the session, the patient gets to know the surgeon and can ask all the questions that bother him. The surgeon examines the patient and verifies that he does not suffer from problems that constitute a risk factor that could interfere with the operation or even prevent it from being performed. The surgeon explains the details of the operation to the patient and answers all questions so that the patient can express consent based on knowledge ("informed consent") about the operation he is to undergo. At the end of the examination, the surgeon coordinates with the patient a suitable time for the operation.

On the evening of the surgery, prepare an envelope containing all the medical documents related to the surgery: the referral letter, the commitment of the health insurance fund/the funding agency and the results of the laboratory tests if you were asked to prepare them in the pre-operative examination. It is advisable to go to bed early on the eve of the operation, get up early in the morning and eat a normal breakfast (in local anesthesia surgery there is no need to fast). All the medications that the patient usually takes should be taken unless The surgeon ordered otherwise in the pre-operative examination. On the morning of the operation, it is advisable to wash the head and wash the face thoroughly (after the operation, it is customary not to wet the area for up to 3 days). It is advisable to wear normal/old clothes (During the operation, the clothes may be stained with blood) and not to wear make-up. It is advisable to stock up on sandwiches and reading material or other means to pass the time since during the day there will be waiting periods which may be long. It is recommended to come with an escort (preferably no more than one) and arrange in advance for an escort/transportation home - the operation may be long and be very tiring.

The operation is performed simultaneously in several patients. The waiting time for the start of your operation depends on the surgeon's prior planning and your arrival time. Since the operation is performed under local anesthesia, music is played in the operating room for your pleasure and sometimes also according to your choice. At the end of each stage of the surgery, the patient goes out bandaged to the waiting room, and waits there until receiving the answer from the surgeon. In the first minutes after leaving the operating room, the bandage should be pressed on the wound to prevent bleeding. In case bleeding starts anyway, the patient can contact the nurse in the waiting room. The waiting time varies according to the load in the laboratory, the stages of the operation in the different patients and the severity of the disease. A "full day's entertainment" must be taken into account. During the wait it is possible and even desirable to drink and eat.

The anesthesia is carried out by injecting an anesthetic into the area of the skin surrounding the tumor. Naturally, the injection involves discomfort and even pain, which will usually be short, 30-60 seconds. In the following steps, we will try to prevent additional pain by adding an anesthetic before the effect of the previous injection wears out. After the operation no significant pain is expected except in exceptional cases. Usually, treatment with paracetamol/Optalgin is sufficient to alleviate the pain in such cases.

Yes. Every surgery leaves a scar. But - surgery using the Moss method leaves the minimum possible scar compared to other methods while optimally removing the cancerous tissue and the surgeon uses special techniques of plastic surgery to achieve optimal results.

In the first months the scar will be reddish, and only later will it clear up. The appearance of the scar will continue to improve during the first year. Exposure to the sun may cause the scar to develop a different shade than the normal skin, so it is recommended to avoid exposure to the sun in the first year. Scars may remain red, stiff, raised (hypertrophic scar or keloid) even a long time after surgery - results mainly related to the patient's wound healing properties.

First, it needs to be emphasized that most MOHS surgeries end successfully and easily without any complication, The following information is to help understand the possible rare complications and how to deal with them. Bleeding - During the operation, bleeding may be caused which may require an intervention to stop it using an electric needle. In such a case, a grounding sticker used to close the electrical circuit and prevent electrocution will be placed on the right hand rail. The patient must let the surgeon know if a pacemaker is installed in his body in order to prevent its operation from being interrupted by the treatment with the electric needle. Several hours after the end of the operation, bleeding may appear due to the disappearance of the adrenaline injected with the anesthetic. It is important to distinguish between bloody discharge - which stains the bandage in red and between bleeding which means that the bandage is filled with blood and blood begins to drip out of the bandage. Blood discharge is expected after every operation and is of no importance. It is not a reason for any intervention. On the other hand, when bleeding appears - the outer bandage must be changed and the wound should be pressed relentlessly for approx. 15-20 minutes. If the bleeding has not stopped, the outer bandage must be changed again and continuous local pressure should be applied. If even then the bleeding continues, contact the surgeon or the hospital (phone numbers to call are included in the discharge letter). Often, a hemorrhage may appear under the eye ("Shiner"), usually on the operated side, and sometimes when the operation was in the center of the face - on both sides. This side effect is due to the fact that the tissue under the eye is spongy and has the possibility of absorbing the blood remaining in the tissue or from small bleeding that continued after the surgery. This side effect is not important and the stain and swelling usually disappear within a week - 10 days at most. Nerve damage - Nerve damage during surgery may cause a disturbance in sensation in the surgical area, and in rare cases even local muscle weakness. In most cases where the tumor involves a significant nerve - the surgeon will explain to the patient the consequences of continuing the operation in light of the expected damage to the nerve and will obtain his consent to continue the operation. In some cases, small nerves may be damaged that the surgeon did not notice. These nerves are usually responsible for small areas and damage to them does not cause a significant functional or sensory disturbance. In most cases, after several months, the sensation in the operated area returns to normal. Hypersensitive reactions (allergy) - the use of local anesthesia may also cause side effects, from very mild to life-threatening, in extremely rare cases due to the patient's allergy to the anesthetic or for other allergans in the surgery room like latex. The anesthetic also contains adrenaline whose role is to cause the arteries to constrict at the site of the operation - to prevent the anesthetic from dispersing and to reduce bleeding from the tissue. Although this is a very low concentration of the substance, some patients may experience rapid heartbeats and a feeling of anxiety. This side effect passes after a short time and is of no importance. Infection - In rare cases there may be an infection in the surgical wound that will require drainage or antibiotic treatment. The signs of infection are pain, local and/or systemic fever, redness around the wound and swelling. In cases where the circumstances of the operation, its duration, the size of the wound or its location increase the risk of developing an infection - the surgeon instructs the patient to take prophylactic antibiotic treatment immediately after the operation. In cases where signs of infection have developed regardless of whether the patient is receiving antibiotic treatment or not - the surgeon should be contacted and informed as early as possible. Problems in wound healing - extremely rarely, wound healing may be extremely slow, disrupted or abnormal. In such situations, the development must be reported to the surgeon so that steps can be taken to correct the situation. In most cases the repair is simple and the final result will be very good. Pain - some of the above complications may be accompanied by pain and local discomfort. In the case of pain that does not go away, worsens, or does not respond to the anti-pain treatment recommended at the end of the operation - it is recommended to contact the surgeon, so that he will consider prescribing a more effective treatment to prevent the pain and/or schedule an examination to make sure that the pain is not related to one of the other complications that require treatment at an early stage.