Mohs Surgery is a specialized, highly effective technique for removing skin cancers. It was developed in the 1930’s by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancer tissue so that all roots and extensions of the cancer can be found and eliminated. Mohs surgery has the highest reported cure rate of all treatments for skin cancer. 

Treating all skin cancers with Mohs Surgery is not necessary. Mohs surgery is reserved for skin cancers that have grown back again after previous treatment, are at high risk for recurring, or which are located in cosmetic areas where preservation of the maximum amount of normal skin is important. 

Mohs Surgery is practiced by physicians who have the advance training, surgical and laboratory facilities and staff to perform this specialized technique. Dr. Myers and Dr. Fotopoulos are members of the American Society for Mohs Surgery.

WHY REMOVE SKIN CANCERS WITH MOHS SURGERY?

Some skin cancers are deceptively large-far bigger under the skin than they appear to be from the surface. These cancers may have "roots" in the skin or along blood vessels, nerves, or cartilage. Also, skin cancers that recur after previous treatments may send out extensions deep under scar tissue that has formed. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous "roots." 

HOW IS MOHS SURGERY DONE?

There are 3 steps involved in Mohs surgery: 

The skin is made completely numb using local anesthetic. The visible cancer is removed with a thin layer of additional tissue. This takes only a few minutes and the patient may then return to the waiting room. A detailed diagram (a Mohs map) of the removed specimen is drawn. 

The specimen is color coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. These slices are placed on microscope slides and stained for examination under a microscope. This is the most time consuming part of the procedure, often requiring an hour or more to complete. 

Our doctors then carefully examine these slides under the microscope. This allows examination of the entire surgical margin of the removed tissue. That is, the entire undersurface and the complete edge of the specimen is examined. All microscopic roots of the cancer can thus be precisely identified and pinpointed on the Mohs map. 

If more cancer is found on the microscopic slides, the doctors use the Mohs map to remove additional tissue only where cancer is present. This allows the Mohs surgery technique to leave the smallest possible surgical defect because no guesswork is involved in deciding where to remove additional tissue. Only tissue around the "roots" and extensions of cancer is removed. 

HOW LONG DOES IT TAKE?

Most cases can be completed in three or fewer stages. However, one cannot predict how extensive a cancer will be, because the size of a skin cancer's "roots" cannot be estimated in advance. We therefore ask that you reserve the entire day for surgery, in case additional surgical sessions are required. 

WILL IT LEAVE A SCAR?

Yes. Any form of surgery leaves a scar. Mohs surgery, however, will leave one of the smallest possible surgical defects, and therefore a smaller final scar.

WHAT HAPPENS AFTER THE MOHS SURGERY IS COMPLETED?

When the cancer is removed, the doctor will discuss with you your options. These may include: 1) allowing the wound to heal naturally, without additional surgery (often produces the best cosmetic result), 2) wound repair by Dr. Myer or Dr. Fotopoulos 3) wound repair by the referring physician or making arrangements for wound repair, or 4) referral to another surgeon for wound closure. 

WILL I HAVE PAIN, BRUISING, OR SWELLING AFTER SURGERY?

Most patients do not complain of significant pain. If there is discomfort, Tylenol is usually all that is necessary for relief. However, stronger pain medications will be prescribed when needed. You may have some bruising and selling around the wound, especially if surgery is being done close to the eyes.

WILL MY INSURANCE COVER THE COST?

Most insurance policies cover the costs of Mohs surgery and the surgical reconstruction of the wound. Please check with your insurance carrier for exact information relating to your surgery. 

HOW DO I PREPARE FOR SURGERY?

Get a good night's rest and eat normally the day of surgery. Also, be sure to shower before coming to the office or the night before. This will ensure that the entire surgical area will be thoroughly cleansed to avoid infection.

Take all prescribed medications, including Coumadin (Warfarin) or aspirin prescribed by your physician. Since your procedure may not be completed till the afternoon be sure to bring extra doses of any medications that you may need.

If not prescribed by your physician avoid aspirin, aspirin-containing medications and Vitamin E for 10 days prior to surgery. Also avoid Ibuprofen (Motrin, Advil, Nuprin) for 48 hours prior to surgery. However you may take Tylenol as needed prior to surgery.

Avoid Alcohol for 48 hours prior to surgery as these can increase the risk of bleeding.

If your surgery is around the eyes and the final bandage will likely obstruct your vision, you must make arrangements for someone to drive you home.

You may want to bring a book or magazine with you to occupy your time while waiting for your slides to be processed. New Image Dermatology does provide Wi-Fi access to make your waiting time more productive.

If you have any questions or concerns about these instructions, please feel free to contact our office.

American Society for MOHS