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Mohs Surgery & Skin Cancer

Learn more about Mohs Surgery and Skin Cancer and view frequently asked questions.

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Mohs Surgery & Skin Cancer

For more information on Mohs surgery, please visit our website mohssurg.com or mohscollege.org.

What is Mohs surgery?

Mohs surgery is a specialized technique of skin cancer surgery named after Dr. Frederick Mohs, who pioneered the special way in which the tissue margins are examined.

Mohs surgery is recommended for:

  • skin cancers on the head and neck
  • aggressive skin cancers (morpheaform, sclerosing or infiltrative basal cell carcinoma, squamous cell carcinoma or Bowen's disease, melanoma-in-situ or lentigo maligna)
  • cancers which have recurred after previous treatment
  • large or unusual tumors (such as microcystic adnexal carcinoma, dermatofibrosarcoma protuberans, eccrine carcinoma, Merkel cell carcinoma)

Mohs surgery has the advantage of finding out the results the same day, rather than facing the risk of having to go back to take more tissue later if the cancer was not completely removed. For this reason, it is considered to be a tissue-sparing technique, only removing the cancer and sparing normal skin, leading to the smallest wound possible.

Some doctors in other specialties state that checking margins is the same as Mohs surgery. It is not. For more information on this please visit mohssurg.com.

Due to thorough examination of the tissue, Mohs has a superior rate of curing skin cancers compared to other methods. We and your referring doctor can explain the risks, benefits and alternatives and why Mohs is ideal for your case.

Why our office for Mohs surgery?

Our practice has special expertise and emphasis in Mohs surgery:

  • Our office has a permanent laboratory and full-time experienced histotechnicians on staff (instead of rented lab and equipment)
  • We are fellowship-trained in Mohs surgery (members of the American College of Mohs Surgery mohscollege.org)
  • Mohs surgery is performed nearly every day in our practice.

What a typical day is like

We may see you in consultation before the surgery is scheduled, or we may consult with you the day of. After taking a history and brief physical examination, we will mark the biopsy site with you. Local anesthetic is used. Patients often ask why we don’t use topical anesthetic. This is time consuming, does not take away all of the pain of injections, and cannot be used on open wounds once surgery has begun. We take special measures to make the injections as comfortable as possible. The area is then excised with a small margin of surrounding skin. Bleeding is stopped and a pressure bandage is applied. It typically takes 1 to 2 hours for your result. During that time you may stay in our waiting room or leave and come back.

If cancer was seen on the slides, it means that the edges or margins were not clear of cancer and another "layer" or "stage" of surgery must be performed. The process then repeats itself until the margins are free of cancer. This typically takes up to 2 stages for most patients, but may exceed this. It all depends on how extensive the skin cancer is.

What about scarring?

Once the cancer is removed, the next goal is the best cosmetic outcome. All surgeries are at risk of scarring. Nonetheless, we have a great deal of experience with wounds big and small in all locations. We will recommend the best options. Some wounds can heal naturally with proper wound care for 6 weeks. Some wounds will have a side-to-side closure, a skin graft (taking skin from another part of the body) or a skin flap (making incisions adjacent to the wound and sliding skin into the wound).

We are often asked if we are plastic surgeons; we are not. As dermatologic surgeons, we have expertise in reconstructive plastic surgery techniques and have extensive experience as fellowship-trained Mohs surgeons. Less than 2% of wounds are referred out for reconstruction. We work with colleagues in plastic, head and neck, and oculoplastic surgery, and you may request this if so desired.

Some scars may be improved with lasers or further minor touch-up surgeries. Most scars look very well after a tincture of time as they mature.

Skin Cancer Screening

We believe in preventative medicine. Skin cancer is the most common cancer of all cancers. Besides melanoma, which is the deadliest, there are basal cell and squamous cell carcinomas. These tumors can look like a normal skin growth. Therefore, a thorough skin exam becomes important to maintain skin health.

We would be happy to perform this service as long as your regular dermatologist or doctor does not already provide this for you.

For more information on skin cancer, click here or visit skincancer.org

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