Mohs Surgery

Treat Skin Cancer With Mohs Micrographic Surgery

If you've been diagnosed with skin cancer, contact our facility to learn more about Mohs Micrographic Surgery, a specialized technique of skin cancer removal with an average cure rate of 99%. Considered the "gold standard" of skin cancer removal, Mohs surgery allows for the highest success rate and least damaging cosmetic results of all other types of surgery.

An Outpatient Procedure That Fits Your Schedule

Mohs surgery has been modified and perfected over the years, since it was originally introduced in the 1930s by Dr. Frederick Mohs. Complete removal of cancer in less than one day. This includes the complete removal of cancer as well as the reconstruction of the affected area.

About Mohs Micrographic Surgery at Rosario Skin Clinic

Mohs Micrographic Surgery (Mohs Surgery) is a specialized technique of skin cancer removal that leads to an average cure rate of approximately 99%. The procedure was pioneered in the 1930s by Dr. Frederick Mohs, and has been modified and perfected over the years. Mohs Surgery is the 'gold standard' of skin cancer removal and allows for the highest cure rate and better cosmetic results than all other types of surgery.

How Mohs Micrographic Surgery Is Performed

Mohs Surgery is an outpatient procedure and is performed in one day. Usually, patients undergoing Mohs Surgery arrive at our office in the morning, and the procedure may last anywhere from several hours, or even the entire day depending on the size and complexity of the skin cancer.

After arrival at our clinic, a brief history and physical exam are performed, and then a local anesthetic is injected into the skin to numb the involved area. The skin cancer is removed using a small incision, and a temporary bandage is placed. Patients then relax in our comfortable waiting room, where we have an assortment of beverages, coffee, a TV, and reading material.

During this waiting time, the patient’s cancer tissue is processed in our on-site laboratory. The 'margins' of the tissue are then examined by the Mohs Surgeon to determine if all the skin cancer is removed. The process of tissue staining and microscopic examination takes approximately 30-45 minutes. If skin cancer still remains at the margins, the patient again returns to the operative suite, where additional tissue representing the remaining skin cancer is removed. This cycle is repeated as many times is as necessary to remove the entire skin cancer. Usually, the cancer is removed in the first or second attempt. However, for large and complex skin cancers it often takes more cycles to allow for complete removal.

After the entire skin cancer is removed, the Mohs Surgeon surgically reconstructs the defect from removal. Occasionally the patient will have the reconstruction performed by another physician.

How Big Is My Skin Cancer

One of the most common misconceptions patients have about skin cancer is that they frequently underestimate the size of the problem. Often skin cancers have the equivalent of 'roots'. These roots often extend well beyond the visible portion of the skin cancer and lead to an iceberg-like phenomenon, where the cancer is actually considerably larger than the portion visible to the naked eye. Thus, while your skin cancer may indeed be small, often patients are surprised at just how far these 'roots' extend. This is why Mohs Surgery is so effective for skin cancer because it uses the microscope to track these skin cancer roots, and only removes cancerous tissue not normal non-diseased skin.

What to Expect the Day of Your Surgery

On the day of your surgery, plan to stay the entire day at our office. Please eat a normal breakfast the morning of your surgery. Although you may be finished early, occasionally complex skin cancers take a considerable amount of time to treat properly. Although we have coffee and light snacks, it is strongly suggested that you bring a lunch.

Although most Mohs surgeries are relatively small and have a very little effect on our patients' lifestyle, patients need to avoid performing the strenuous physical activity for at least 1-2 weeks after surgery. We recommend this because physical activity raises blood pressure and can increase your chance of post-operative bleeding, blood clots, infection, and poorer cosmetic outcomes.

Once the Skin Cancer Is Removed, How Is the Surgical Defect Repaired?

Mohs surgery is a highly accurate method of removing skin cancers, and is referred to as being 'tissue sparing'. Tissue sparing means that less normal, non-diseased skin is removed in the Mohs process. Hence, this leads to a smaller surgical defect and a less complex surgical reconstruction. However, some skin cancers are particularly destructive and may leave large areas where the skin and other tissues have been removed. A variety of surgical techniques can be used for this reconstructive process. Understanding the technique of surgical closure is important for prospective surgery patients.

One common source of confusion is the relationship between the size of the defect, or 'hole', made by removal of the skin cancer, and the final length of the surgical scar. Anyone who has knitted knows that if you try and knit a circle to a line, the fabric bunches at the ends. Because of this, it is often necessary to remove additional normal skin in order to camouflage the incision line. The ratio of the 'defect' diameter to the final surgical scar is usually around 1 to 3. This means that the incision line will be approximately 3 times the diameter of the skin cancer. This is illustrated in the figures below. However, occasionally it is necessary to perform a skin graft or skin flap, and the length and width of the scar can vary in these circumstances.

Medications

We suggest that you continue to take all of your medications prescribed by your doctor up to, and including, the day of your surgery. This includes, but is not limited to, blood thinners such as Plavix, aspirin, and Coumadin. Although these may slightly raise your chance of bleeding with your surgery, it is usually a very minor problem compared with the complications of stopping these medications. If you are concerned with these recommendations, please talk to your doctor who prescribed these medications for their recommendations prior to your surgery day.

Medical Conditions

If you have undergone hip, knee, or joint replacement, we recommend that you talk to your orthopedic doctor about taking prophylactic antibiotics prior to surgery. If your doctor recommends this, please bring the medication, such as amoxicillin, with you to your appointment.

If you have a heart condition that requires you take preoperative antibiotics, such as valve replacement surgery or mitral valve prolapse, please also talk to your cardiologist about taking antibiotics prior to your surgery.

Consultations

If you have been diagnosed with a skin cancer and desire to talk with a Mohs Surgeon, please call our office to schedule a consultation for Mohs Micrographic Surgery.

Call Rosario Skin Clinic at 360-336-3026 to schedule an appointment.