Mohs Surgery
We offer surgical skin cancer treatment with the Mohs micrographic surgery technique. In Mohs surgery, your dermatologist is your skin cancer surgeon and the pathologist examining tissue removed during surgery. The technique involves removing the visible area of tumor along with a thin margin around and deep to the tumor. The tissue is divided and marked with ink to correspond with a map that is used to know where to take more cancer out if some is left behind. The tissue is frozen and sliced into thin sections that are placed on slides. We examine the tissue on these slides to know if there is still tumor present at any of the edges of what was removed. Sometimes the tumor is completely removed in the first stage. Sometimes two or more stages of surgery are required to completely remove the tumor. Each time, a map is used to correctly identify where additional tissue needs to be removed.
The entire Mohs surgery procedure takes place in our office within one day. You may be done in about an hour, or you may be in our office for many hours depending on how many stages are required to confirm that the skin cancer has been completely removed. One the cancer has been removed, we may allow the skin to heal in on its own, or we may close the surgical wound with sutures. In some cases, the required closure may be cosmetically challenging, and we will refer you to a plastic surgeon for the best outcome possible.
Mohs surgery is a powerful technique with great outcomes. It is skin sparing, meaning that we only remove the least amount of skin necessary to completely remove the skin cancer. This is especially important on the face or ears. Also, the recurrence rate for mohs surgery is lower than for any other surgical or non-surgical treatment option for treating skin cancer. Not all skin cancers should be treated with Mohs surgery. We will advise you about your best option or options for treatment. If you desire treatment by a plastic surgeon because of concerns about cosmetic outcome, depending on the type of cancer and its size and location we will likely recommend Mohs surgery by your dermatologist followed by closure by your plastic surgeon.
Please make an appointment to see us if you are concerned about any type of suspicious skin lesion. Expert dermatology evaluation is important, and if a skin cancer is suspected we may recommend and perform a biopsy.
Mohs surgery may be recommended for certain types of skin cancer depending on the type, size, and location of the skin cancer. Some forms of skin cancer are locally agressive, which would be a reason for Mohs surgery. Other types of skin cancer spread to other parts of the body easily and are need to be removed with a measured margin of normal skin. In these cases Mohs surgery would not be recommended. We will discuss recommended treatment options with you and whether or not Mohs surgery is an appropriate treatment for your type of skin cancer.
Because it involves a special multi-step process including a specialized worker in a laboratory in our office, Mohs surgery is typically slightly more expensive than other skin cancer treatments. This is true in any office, and we use standard pricing. It is important to consider the advantages of the Mohs technique, which include sparing as much healthy skin as possible, having the lowest recurrence rate of any treatment option, and confirming same day that the skin cancer has been completely removed. We will work with your insurance to make sure the procedure is covered before your appointment, and our billing specialist is happy to provide you with estimated insurance reimbursement rates and information about total costs.
Mohs surgery is covered by most insurance plans, including Medicare. Our billing specialist will work with your insurance to make sure it is appropriately covered before your appointment.
Some amount of visible scar is likely after any surgical procedure. The appearance of a scar after Mohs surgery will depend on several factors, including size and location of the final defect, individual skin characteristics, your overall health, whether you smoke, if the wound heals appropriately without infection, and the reconstruction options available. Mohs surgery is tissue-sparing, which means that the eventual scar is often smaller and less noticeable than with other methods for removing a skin cancer. We are trained with advanced closure techniques, but we will also refer you to a trusted plastic surgeon for more complex closures after completing Mohs surgery. In many cases, closure is not necessary, and the body will heal very well on its own through a process called secondary intention wound healing.
In many cases, Mohs surgery is recommended over other forms of skin cancer removal. This should only be performed by a dermatologist with specialized training in Mohs surgery, due to the histopathology component of the procedure. Plastic surgeons are not trained to perform this important aspect of the procedure. It is very reasonable to discuss the option of having a plastic surgeon perform the closure following Mohs surgery if this is your preference. We are very happy to help coordinate this type of shared treatment approach.
The American College of Mohs Surgery (ACMS) and the American Society for Mohs Surgery (ASMS) are both professional medical societies comprised of practicing Mohs surgeons. Each organization encourages high-quality continuing medical education and quality assurance measures for its members. Both organizations offer membership to Mohs technicians who provide technical support to their member physicians and are an important part of offering the technique.
The primary difference between the two organizations is that the ACMS sponsors a post-residency fellowship training in Mohs surgery, while the majority of ASMS members received their specialized Mohs training during residency and in post-residency training courses or preceptorships. The ACMS fellowship training is an option for additional training, which may or may not be necessary depending on a Mohs surgeon’s training during dermatology residency and/or other training experiences. With a strong emphasis on education, the ASMS requires regular case submission for peer review, test certification, case volume, and encourages ongoing training to enhance proficiency in Mohs surgery and other dermatologic procedures.