Mohs Surgery for Skin Cancer
What is Mohs Micrographic Surgery?
Mohs Micrographic Surgery (Mohs Surgery for short) is a highly precise method of removing skin cancer in which the diseased tissue is removed in stages. Some skin cancers appear small on the surface of the skin, but actually enlarge as they go deeper. These extensions may be unpredictable and invisible to the naked eye. Mohs Surgery was designed to track the roots under the microscope to ensure that they are completely removed.
Differing from standard surgical excision, Mohs surgery is unique in the method of removal of the affected skin tissue and how it is processed and examined. This surgery is performed in our office using local anesthesia.
How is Mohs Micrographic Surgery different from a standard excision?
During standard excisions, a football shaped piece of tissue including and surrounding the skin cancer is removed. The tissue is sliced top to bottom and laid onto slides for examination. While this is often adequate for skin cancers on the arms, torso or legs where there may be extra skin to take a wider margin, it is not ideal for cosmetically sensitive areas such as the face and back of hands.
Mohs Surgery involves removing the skin cancer in stages that begin with a saucer-like piece of skin that includes the tumor plus a small margin of surrounding skin. While remaining in the office, the tissue is mapped, inked and processed onto slides for examination in such a way that 100% of the surgical margin can be examined. If skin cancer cells are seen in the removed tissue, another stage is removed in the exact location, leaving normal skin intact. By this method, as many non-cancerous skin cells are saved as possible. Once the skin cancer has been completely removed, Dr. Schlesinger will explain the various options for closure and repair of the wound.
How Effective is Mohs Surgery?
Because the Mohs Micrographic Surgery process involves a systematic microscopic search which traces skin cancer extensions until they are undetected, it offers the highest chance for cure while sparing the surrounding normal tissues. Studies performed around the world have repeatedly demonstrated that Mohs surgery has a 99% five-year cure rate for new skin cancers and a 95% rate for recurrent cancers.
What Type of Training is Required to Perform Mohs?
Dermatologists are uniquely qualified to perform Mohs largely due to their training and expertise in skin cancer pathophysiology, cutaneous (skin) histopathology, dermatologic surgery, and repair of complex defects. Those interested in performing Mohs may receive their training in dermatology residency programs, through fellowships, courses and preceptorships.
Having extensive experience performing Mohs surgery and post-Mohs reconstruction, Dr. Schlesinger has performed this type procedure for over 10 years. He has satisfied the training and testing requirements to become a Fellow of the American Society for Mohs Surgery, a professional organization dedicated to Mohs with over 850 members, and as a surgical graduate of the world renowned Cleveland Clinic Foundation, he also received training in Mohs Surgery and additional post-graduate training at the Scripps Clinic in La Jolla, California.
Why Has Mohs Surgery Been Recommended for my Skin Cancer?
Mohs Micrographic Surgery is usually used to treat basal cell carcinomas and squamous cell carcinomas. It is often recommended when:
- The skin cancer is in an area where it is important to preserve healthy skin for the best cosmetic and functional outcome. Examples include the face, nose, lips, ears, eyelids, hands, feet and genital areas;
- The cancer was treated before and has come back (recurred);
- Scar tissue exists near or within the cancer;
- The cancer has become large;
- The edges of the cancer are not clearly defined;
- The cancer is growing rapidly or out of control;
- The cancer is of a specific subtype that is aggressive.
How do I schedule a Mohs Surgery?
Once your biopsy results are received, our surgical coordinator will be in touch to schedule your removal surgery.
What Will my Mohs Surgery Day be Like?
Mohs Surgery is performed in our office as an outpatient surgery under local anesthesia. Meaning that the area to be treated is numbed and kept numb throughout the procedure until you go home. Your Mohs Surgery day will begin early morning, between 8am and 9.30am. You are asked to have breakfast, take your medications and drink plenty of water, while avoiding caffeine as it may interfere with the anesthesia. Please be sure to ask Dr. Schlesinger or his staff about any prescription medications prior to your surgery date.
Once the first stage has been removed, you will wait in one of our comfortable lounges while our histotech processes the sample and Dr. Schlesinger examines the margins. Please bring a blanket and something to read or occupy yourself. If necessary, you will be called in for a second or additional stage. Once the cancer has been completely removed, your reconstruction will be discussed with you and performed in one of our surgical suites. Our Mohs lounge is complete with television, reading material and plenty of decaffeinated coffee, breakfast snacks and water. We ask that you limit the number of accompanying family or guests to one person and that no children be brought with you or your guest on the day of surgery.
If you have any questions about an upcoming Mohs Surgery date or would like to schedule an appointment to have your skin examined by our board-certified dermatologist or dermatology physician assistant, please contact our office.