Mohs Surgery at Treasure Coast Dermatology

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Treasure Coast Dermatology Mohs Surgery Page

What is Mohs Micrographic Surgery?

Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer. The procedure was developed in the 1930's by Dr. Frederick 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 cancerous tissue, so that all "roots" and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.

Special Qualifications of the Mohs Surgeon

Physicians performing Mohs surgery should have specialized skills in dermatology, dermatologic surgery, dermatopathology, and Mohs surgery. Basic and advanced training in Mohs surgery is available through selected Residency programs, specialized fellowships, observational preceptorships, and intensive training courses. In addition, the Mohs surgeon must have the required surgical and laboratory facilities and must be supported by a well-trained Mohs nursing and histotechnological staff. Your Mohs surgeon can provide you with detailed information regarding his or her training in the above disciplines, as well as all applicable professional affiliations.

Advantages of the Mohs Surgical Procedure

Some skin cancers can be deceptively large-far more extensive under the skin than they appear to be from the surface. These cancers may have a "root" in the skin, or along blood vessels, nerves, or cartilage. Skin cancers that have recurred following previous treatment may send out extensions deep under the scar tissue that has formed at the site. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous "roots". For this reason, prior to Mohs surgery it is impossible to predict precisely how much skin will have to be removed. The final surgical defect could be only slightly larger than the initial skin cancer, but occasionally the removal of the deep "roots" of a skin cancer results in a sizeable defect. The patient should bear in mind, however, that Mohs surgery removes only the cancerous tissue while the normal tissue is spared.

Patient Preparation for Surgery

If you are taking prescription medications, continue to take these unless otherwise directed by a physician. However, you should inform your Mohs surgeon if you are taking blood-thinning medications such as coumadin, Plavix, aspirin, aspirin substitutes (such as Advil, Motrin, Nafton, Naprosyn, etc.), vitamin E, ginkgo, garlic, ginseng, ginger, ephedra or other nutritional supplements. These medications and supplements can sometimes cause an increased chance of bleeding after surgery.

It is important that you obtain a good night's rest and eat normally on the day of your surgery. For your comfort, it is recommended that you wear casual, layered clothing. You may also wish to bring a light snack and a book or magazine to help occupy your waiting time. Also, it may be advisable to arrange for someone to drive you home following surgery, if needed.

Duration of Procedure

Most Mohs cases can be completed in three or fewer stages, requiring less than four hours. However, it is not possible to predict how extensive a cancer will be, as the extent of a skin cancer's "roots" cannot be estimated in advance. Therefore, it is advisable to reserve the entire day for this surgical procedure, in case the removal of additional layers is required.

Minor Post-Surgical Discomfort Expected

Most patients do not complain of significant pain. If there is some discomfort, normally only Tylenol is required for relief. However, stronger pain medications are available and will be prescribed when needed. You may experience some bruising and swelling around the wound, especially if surgery is performed near the eye area.

For small post-surgical sites, direct closure by suturing the sides of the wound together may be possible. However, in certain areas of the body, there is very little tissue that can be stretched for coverage of a wound, and either a skin graft or skin flap must be used. In closing wounds with a skin flap, the skin adjacent to the surgical defect is partially cut free, and then rotated or moved forward to cover the surgical area. Stitches are then placed to hold the flap in its new position. This provides immediate coverage for the wound. Other areas may require a skin graft to provide coverage. Skin from the side of the neck, behind the ear, or over the collarbone may be cut free, placed over the wound, and then sewn into place. The original site of the graft is then closed with stitches or allowed to heal on its own.

Wound Healing, Scarring, and Scar Revision

If your wound requires daily care at home, you will be given detailed instructions following your surgery. As with all forms of surgery, a scar will remain after the skin cancer is removed and the surgical area has completely healed. Mohs micrographic surgery, however, will leave one of the smallest possible surgical defects and resultant scars. Often, wounds allowed to heal on their own result in scars that are barely noticeable. Even following extensive surgery, results are frequently quite acceptable. In addition, scars do have the ability, through the body's own natural healing properties, to remodel and improve in appearance for a six to twelve month period. There are also many other techniques available to the patient for enhancement of the surgical area following skin cancer surgery.

Potential Complications Associated with Mohs Surgery

Patients should understand that there is not an absolute guarantee that any given procedure will be totally free of complications or adverse reactions. Mohs surgery is no exception. During surgery, tiny nerve endings are cut, which may produce a temporary or permanent numbness in and around the surgical area. The surgical area may remain tender for several weeks or months after surgery, especially if large amounts of tissue were removed. Rarely, some patients experience intermittent itching or shooting pain in the surgical area. In addition, the skin grafts and flaps used to cover surgical areas may not fully survive, requiring additional repair.

Mohs Surgery Has Highest Surgical Cure Rate

Mohs surgery has the highest surgical cure rate for both basal cell carcinoma and squamous cell carcinoma, reports Jonathan Sanders, MD, JD. For basal cell carcinoma, the technique produces approximately a ninety-nine percent cure rate, with just a slightly lower cure rate for squamous cell carcinoma.

The Mohs procedure is named for Dr. Frederick Mohs, who developed the surgery in the 1930s at the University of Wisconsin. The Mohs procedure involves removing successive layers of tissue and immediately examining them with a microscope, so that all of the roots and extensions of the cancerous lesion can be eliminated.

Dermatologists that perform Mohs surgery must have specialized skills in dermatology and dermatologic surgery. Training for Mohs surgery is available through select residency programs, specialized fellowships, and intensive training courses. Drs. Ioannides and Sanders are both members of the American Society for Mohs Surgery.

The entire procedure can take several hours to complete, but actual surgical time may be measured in just minutes. Most of the time is spent in careful preparation and scrutiny of the excised tissue.

Mohs surgery succeeds
where others have failed

This procedure has the highest surgical cure rate for both basal cell carcinoma and squamous cell carcinoma,

The Mohs technique involves removing successive layers of tissue and immediately examining them with a microscope to determine at what point all signs of cancer have been excised.

The entire procedure may take a few hours to complete, but actual surgical time is much less. Most of the time is spent in careful preparation and scrutiny of the excised tissue.

If cancer cells are still evident in a layer of tissue, another thin layer is excised during the same procedure, explains Dr. Sanders. The process is repeated until all the cancer cells are removed, preserving as much healthy tissue as possible around the site of the lesion.

Sunscreen Got You Covered?

The sun is necessary for life, but too much sun exposure may lead to poor health. More than one million people in the United States are diagnosed with skin cancer each year. However, skin cancer is largely preventable if people protect themselves from the sun, so whether it's a cool day in January or a sunny day in July, the board-certified physicians of Treasure Coast Dermatology are here to help you play it safe outdoors.

Remembering Your ABC's
Can Save Your Life

It sounds almost too simple to be true, but the same little song that got you through kindergarten could now save your life. Best of all, you don't even have to be able to carry a tune to use this tool. Every sixty-seven minutes, someone dies of melanoma; a sad statistic that does not have to be. According to the American Academy of Dermatology, skin cancer is the most prevalent of all types of cancer and affects more than one million Americans every year.