Mohs Surgery

What is Mohs Surgery?

Mohs surgery is a specialized, highly effective technique for removing skin cancers, named for Dr. Frederic Mohs, who developed it in the 1930’s at the University of Wisconsin. It is now practiced worldwide by physicians who have the advanced training, surgical and laboratory facilities, and staff to perform this specialized technique.
Mohs is different from other skin cancer treatments and has the highest reported cure rate of all treatments for skin cancer. It is the preferred method of treatment for certain skin cancers because it includes immediate and complete microscopic examination of the removed cancer tissue to determine that all roots and extensions of the cancer have been found and eliminated.

It is not necessary to treat all skin cancers with Mohs surgery; however, it is the best treatment for skin cancer when:

• skin cancers have grown back after previous treatment;
• a person is at high risk for recurring skin cancers;
• the skin cancer is located in a cosmetic area where preservation of the maximum amount of normal skin is important.

The Benefits of Mohs Surgery

Mohs surgery is designed to remove cancers by tracking down and removing cancerous roots that are not seen on the surface. Some skin cancers are deceptively large, being far bigger under the skin than they appear to the eye. These cancers may send out roots in the skin or along blood vessels, nerves, or cartilage. Also, skin cancer that has grown back after previous treatments may send out extensions deep under the scar tissue that has formed.
By removing cancerous roots, Mohs surgery is clearly the most complete and effective treatment for these types of cancers.

Frequently Asked Questions about Mohs Surgery

How long does it take?

Most cases can be completed in three or fewer stages; this often takes 1-4 hours. However, no one can predict how extensive a given cancer is because the size of the skin cancer's root cannot be estimated in advance; therefore you should plan nothing else for that day.

Will it leave a scar?

Yes. Any form of surgery leaves a scar; however, one of the advantages of Mohs surgery is that it leaves one of the smallest possible surgical defects, and therefore a smaller final scar. The doctors at Affiliated Dermatology have a special interest in aesthetic repair. They will use the latest in surgical techniques to repair the defect in a cosmetic fashion.

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, if stronger pain medication is needed, it will be prescribed. There may be some bruising and swelling around the wound, especially if surgery is done close to the eyes. Sometimes it helps to use an ice pack for short periods of time during the first few days and to sleep with the head slightly elevated.

How much “down time” should I expect?

Normally suture removal is in 1-2 weeks. During this time normal daily activities such as walking and driving are usually allowed. Heavy exercise and strenuous activities during this time should be strictly avoided, as it may lead to complications and an increased risk of scarring.

Will my insurance cover most of the cost?

Most insurance policies including Medicare cover the cost of both Mohs surgery and the surgical reconstruction of the wound. Please discuss any questions you may have with our office insurance coordinator.

Other Treatment Options

When basal or squamous cell carcinomas are found on parts of the body other than the face and neck, direct excision is usually the treatment of choice. Other removal techniques less often used in these cases include liquid nitrogen, excision, electrodessication and curettage, radiation therapy, and topical chemotherapy creams such as Aldara® and Efudex®. These procedures have cure rates ranging from 50% to 95%, with excision and/or radiation therapy being the most effective. It is important to remember that cure rates are always higher when cancer is detected at its earliest stages. For this reason we recommend a yearly in-office full body exam.

Treatment options for melanoma will vary depending on the microscopic thickness of the tumor, and if it has spread.

For a closer look at these before and after photos, as well as photographs taken during surgery, click above.
Please be advised that these surgical photos are very graphic.