Mohs Surgery

Did you know that skin cancer is the most common form of cancer in the United States with 1 in 5 Americans developing it in the course of their lifetime? It is also the easiest to cure, if diagnosed and treated early. Believe it or not, the most common skin cancers can present as a small “pimple” which can be diagnosed during a skin examination.

Mohs surgery is a highly specialized procedure that relies on the accuracy of the microscope, instead of the human eye, to ensure that all cancer cells are removed when a skin cancer is treated. It is named after Dr. Frederic Mohs who developed the technique. With Mohs surgery, unlike standard surgical excision, 100% of the surgical margin is evaluated by the surgeon to detect “roots” of the skin cancer. Hence, Mohs Surgery offers the highest cure rate (99% for primary Basal Cell Carcinoma and Squamous Cell Carcinoma) while sparing normal and healthy tissue. Mohs surgery requires the specialized skill and training of a Mohs dermatologic surgeon who serves as surgeon, pathologist and reconstructive surgeon. Dr. Sadeghi has performed over 2000 cases of Mohs surgery and is strongly committed to patient care and the treatment of skin cancers, with a focus on achieving superior cosmetic outcomes.

While any board certified dermatologist may perform Mohs surgery, only members of the American College of Mohs Surgery (ACMS) have undergone rigorous fellowship training. Chosen through an extremely competitive review and selection process, fellows are required to complete an intensive 1 or 2-year post-residency ACMS fellowship training program. This extensive training includes participation in at least 500 Mohs surgery cases under the supervision of an experienced ACMS-approved Mohs surgeon.

Mohs surgery fellowship training programs must pass a rigorous application and review process before being allowed to train a fellow. Once the training program is approved, it must continue to adhere to the standards set by the Mohs College. All ACMS-approved training programs are periodically re-evaluated on a 1 to 5-year basis to ensure that their academic and clinical requirements are being followed and fulfilled.

 

Frequently Asked Questions about Mohs

 

What is Mohs surgery?

Mohs surgery is a highly specialized procedure that relies on the accuracy of the microscope, instead of the human eye, to ensure that all cancer cells are removed when a skin cancer is treated. It is named after Dr. Frederic Mohs who developed the technique in the 1930’s. With Mohs surgery, unlike standard surgical excision, 100% of the surgical margin is evaluated by the surgeon to detect “roots” of the skin cancer. Hence, Mohs Surgery offers the highest cure rate (99% for primary Basal Cell Carcinoma and Squamous Cell Carcinoma) while sparing normal tissue. Mohs surgery requires the specialized skill and training of a Mohs dermatologic surgeon who serves as surgeon, pathologist and reconstructive surgeon. Dr. Sadeghi has performed over 2000 cases of Mohs surgery and is strongly committed to patient care and the treatment of skin cancers, with a focus on achieving superior cosmetic outcomes.

What happens the day of surgery?

Our staff will escort you into the surgical suite where Dr. Sadeghi will numb the area around the skin cancer. Once it is numb, the visible cancer and a thin layer of tissue will be removed. This tissue is carefully mapped by Dr. Sadeghi and taken to our laboratory where the technician prepares slides to be examined under the microscope. You will have a temporary bandage placed over the wound and you will be free to return to the waiting room. The surgical procedure alone takes 15-20 minutes. However, it takes a minimum of 1-2 hours to prepare and examine the slide for each layer. Several stages may be required to completely remove every cancer cell. You will be asked to wait in the waiting room between stages. Although there is no way to tell how many stages will be necessary, most skin cancers are removed in three stages or less.

The most difficult part of the procedure may be waiting for the results. Since we do not know in advance how much time is necessary to completely remove your skin cancer, we ask that you make no other commitments on the day of your surgery. After your skin cancer is completely removed, the open area of the skin will be repaired and stitched. Depending on the location and size of the area, Dr. Sadeghi will discuss one of the following repair options:

  1. Repair the wound by stitching it side to side
  2. Close the wound with a skin flap or graft
  3. Leave the wound open to heal itself

This decision is based on the safest method that will provide the best cosmetic results. Rarely other surgical specialists may be utilized for their unique skills if warranted.

What complications may occur?

Complications after Mohs surgery are rare, but may include a chance of bleeding or infection. For any complications or questions after surgery, please review the written instructions we will provide on the day of surgery.

Will the surgery leave a scar?

Yes, any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized.

Will I have pain after surgery?

There may be some mild to moderate discomfort especially in the first 48 hours post-operatively. Extra Strength Tylenol is all that is usually necessary for relief and if needed alternative pain medication will be prescribed. A sensation of tightness and itching is normal after surgery and may take months to resolve.

What else should I know about the day of the surgery?

Because of the time it takes to process the removed skin cancer, it is advisable to bring reading material or something to occupy your time while you wait.

As mentioned before, please do not make any commitments for that day and plan on going home and resting after the surgery.