Informed consent: Mohs micrographic surgery

Mohs micrographic surgery is a unique technique used to treat skin cancer. The operation is named after its inventor, Dr. Fredrick Mohs. The surgical technique is effective for most skin cancers, but is used primarily to treat basal cell carcinomas and squamous cell carcinomas.

The Mohs surgery is conducted under local anesthesia, and, very infrequently, under general anesthesia. The operation involves resection of the affected tissue in thin layers throughout the perimeter and depth of the tissue. The resected tissue is mapped and processed in a laboratory adjacent to the operating room, using frozen sections, and examined under a microscope by the surgeon. Additional resections of any remnant cancer tissue are performed in the same manner, until healthy tissue is identified under microscopy.

When the resection is complete, the damaged region is reconstructed. Reconstruction is performed by suturing the skin side to side, if possible, or by moving skin from an adjacent area (flap), or by implanting skin removed from a remote site. Recovery time following the operation until removal of the sutures is usually 7 to 14 days.

A scar will remain at the surgical site. In many cases, it is delicate and nearly invisible, and in certain cases it is more apparent. The form of scarring is also dependent on each patient's skin structure and wound healing reaction.

The Mohs micrographic surgical technique results in the highest healing rates and lowest recurrence rates for the tumor, and enables maximal preservation of healthy tissue, thus reducing the potential for scarring or deformation.

The extent of resection and absent tissue following the primary operation cannot be estimated prior to surgery. Tissue loss is often much greater than the size of the tumor apparent to the eye before the primary operation.

Alternative treatment options relevant to these circumstances include: resection without microscopic control, freezing with liquid nitrogen, local radiation, or destruction of the tumor by laser, each with its own benefits and risks and the tests and procedures involved.

Side effects following the primary operation include: redness, swelling, pain and discomfort.

Possible complications during the primary operation and following it include: local hemorrhage, local infection, opening of the sutures, and non-merging of the flap or graft as a result of the complications mentioned.

These complications are not common.

Consent is also given to the administration of local anesthesia, after an explanation of its possible complications, including various degrees of allergic reaction to the anesthetic drug.

If the decision is made to perform the operation under general anesthesia, an explanation regarding the anesthesia is given by an anesthesiologist.

The operation and any other procedure will be performed by any designated person, according to the institutional procedures and directives. There is no guarantee that it will be performed, fully or in part, by a specific person, as long as it is performed in keeping with the institution's standard degree of responsibility and in accordance with the law.