Mohs Micrographic Surgery Informed Consent
Benefits of Mohs Surgery:
-Mohs surgery has the highest published cure rates for all forms of therapy for skin cancers. Mohs
surgery is reported up to 99% effective for previously untreated skin cancers and about 85% effective for
skin cancers that have failed previous treatment attempts. Cure rates are also influenced by factors such
as size, location, and type of skin cancer.
-Mohs surgery spares the most amount of normal skin. Because the Mohs surgeon carefully checks all
the margins of the cancer excision under the microscope, less normal tissue has to be initially removed.
Final, tumor-free defects, following Mohs surgery reflect the unique growth configuration of the tumor
and not arbitrary excision margins. Often the defects are smaller, simplifying reconstruction.
Risks of Mohs Surgery:
-Infection at the surgery site occurs in approximately1-2% of patients.
-Bleeding occurs in approximately 1% of patients.
-Damage to sensory nerves is common and usually resolve completely or partially within a year.
Sometimes this sensory change can be permanent.
-Damage to motor nerves (nerves that move the muscles of facial expression) is rare but is typically
permanent. Nerves that control the muscles that lift the brow and curl the lower lip are most vulnerable to
injury. Sometimes they must be sacrificed if invaded by tumor.
-Scar formation will result from any skin surgery. Thick, raised scars are uncommon in facial surgery. A
second procedure is needed to improve a scar left by Mohs surgery in less than 10% of cases.
-Allergic reactions to local anesthesia or to latex gloves are very rare. If you believe you are sensitive to
these, please let us know.
Alternatives to Mohs surgery:
Patients may choose to have their skin cancers: not treated (risky and not recommended), have them
removed with regular excision (up to 90% cure rate for primary tumors), or treated with destruction, or
radiation.
Reconstruction:
Repair of the defects left following removal of skin cancers is guided by the goals of providing the best
possible aesthetic outcome with the least possible risk and morbidity. Common options include: simple
closure with stitches, skin flaps which burrow adjacent skin to fill a defect, and skin grafts which borrow
distant skin to patch a defect. Some defects heal best by simply letting them heal, without any further
surgery. There is always a small chance that tissue moved in a repair will not “take”, that is, it will not
survive. This most commonly occurs in smokers. Some defects, such as eyelid defects, are referred to
other specialists for repair.
CONSENT TO TREATMENT
1.
I, ____________________________, do hereby agree to the performance of
Mohs surgical excision, under local anesthesia, of my skin cancer and subsequent
reconstruction at the anatomical site of: ___________ by my physician, Dr. John
Boyer, M.D.
2.
I consent to the performance of operations and procedures in addition to or
different from these now contemplated, whether or not arising from presently
unforeseen conditions, which Dr. Boyer may consider necessary or advisable in the
course of the operation.
3.
The risks and benefits of the procedure have been explained to me. These
include, but are not limited to: bleeding, scarring, infection, tumor recurrence, and
damage to motor or sensory nerves. I also understand that there are certain
medical and surgical alternatives to this procedure and I have been given
information regarding other medically and surgically feasible forms of care. I
acknowledge that no guarantees have been made to me concerning the results of
the operation or procedure.
4.
I permit John D. Boyer, M.D. to take photographs of me for educational and
teaching purposes during the course of my treatment. The photographs and
information relating to my case may be published or used for any other
professional purpose.
5.
I permit John D. Boyer, M.D. to call my home or other alternative location
and leave a message on voice mail or in person pertaining to my clinical care,
including laboratory and pathology results among others.
6.
I hereby freely and voluntarily give my signed authorization and request for
this procedure.
7.
I have also read the information on the reverse side of this consent.
_____________________________
Signature of Patient
Date & time
I have counseled the above patient as to the nature of the proposed procedure,
attendant risks involved, and the expected results, as described.
_____________________________ _____________________________
John D. Boyer, MD
Date
Witness