Mohs Patients Have Good Results
Having any type of surgery can be scary. If your dermatologist recommends Mohs, you can take comfort in knowing a few facts. Mohs has a high cure rate. Your surgeon will remove the least amount of skin needed to treat the cancer.
Image used with permission of Journal of the American Academy of Dermatology: J Am Acad Dermatol. 2007 57:832-5.
ReferencesNouri K, Patel AR, et al. Mohs micrographic surgery. In: Nouri K. Skin Cancer. The McGraw-Hill Companies, Inc., China, 2008:482-490.
Schaeffer M, Geisler A, et al. Patient-reported preferences associated with Mohs micrographic surgery of nonmelanoma skin cancer: Relative importance of factors pertaining to surgeons and staff during the perioperative course. Poster presented at: 74th Annual Meeting of the American Academy of Dermatology 2016 Mar 4-8 Washington, DC. Commercial support: None identified.
Stigall LE, Brodland DG, et al. The use of Mohs micrographic surgery for melanoma in situ of the trunk and proximal extremities.J Am Acad Dermatol. 2016 Nov 75:1015-121.
Walker E, Mann M, et al. Rapid visualization of nonmelanoma skin cancer.J Am Acad Dermatol. 2017 Feb 76:209-16.
What Can I Expect At The Mohs Clinic
Your first appointment will consist of a preoperative consultation. It is often done in the clinic but in many cases screening can be done over the telephone. This visit is critically important to assess, coordinate, plan and prepare you for surgery. Please understand that Mohs surgery is not performed on the consult day.
The surgeons at the Michigan Mohs clinic are board certified physicians specializing in the Mohs procedure. We offer a comfortable setting for the out-patient procedures and our staff of nurse practitioners, nurses and medical assistants will provide you with the personal attention and care you need to make every effort to minimize trips but want to insure that the surgery is performed in the best way possible.
Advantages Of Mohs Surgery
- The surgery results are precise. The doctor examines 100 per cent of the tumor margins, while keeping healthy tissue and leaving a very smallest of scars.
- Mohs is cost effective and an efficient treatment, done as an outpatient procedure and usually only requires a single visit. The surgeon uses local anesthesia and sometimes an on-site lab
- Mohs offers the highest skin cancer cure rate, with up to 99 per cent for skin cancers that havent been treated before and 94 per cent for recurring from previous treatment.
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What To Expect After Your Surgery
If you do any physical labor at your job, please plan to take off the two days after surgery. We ask that you take it easy for at least 48 hours after surgery to minimize complications such as bleeding or problems with your stitches. We can provide a work note during your visit.
Usually, you will be seen the following week to get your stitches out unless you live far away and we will coordinate having your stitches out closer to home. Often times there is a second visit a month after surgery to check on your healing. Additional visits may be needed and will be made based on your individual needs.
Skin Cancer & Mohs Surgery
A skin cancer diagnosis can be a scary and stressful time, but treatment is possible and new technologies have greatly improved outcomes. Our Fellowship-Trained Surgeons, Dr. Joseph L. Cvancara, Dr. Courtney Gwinn, Dr. Joel K. Sears, and Dr. Chadd J. Sukut are experts in a leading outpatient procedure called Mohs Micrographic Surgery, a cutting-edge technique that sees cure rates as high as 99%. Read on to find out more about Mohs Surgery, its results, and whether its the right treatment for you.
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What Types Of Skin Cancer Does Mohs Surgery Treat
Most commonly Mohs surgery is used to treat basal cell carcinoma and squamous cell carcinomas. Skin cancers may destroy the skin and structures where they grow and might be fatal if left untreated. However, skin cancers treated with Mohs surgery usually do not spread to other parts of the body.
Skin cancer will not go away on its own and while it may seem to heal over time, if untreated, they always come back bigger, and with deeper roots. While the removal of skin cancer is not an emergency, it should be removed within a month or two of diagnosis. Read more about skin cancer here.
What Are The Risks Of Mohs Surgery
Mohs surgery is performed with local anesthesia. This removes the common surgical risks that come with using general anesthesia.
Risks that are associated with Mohs surgery include temporary bleeding, pain, and tenderness around the area being removed. More serious problems can occur, but they are rare. These include keloid scarring and permanent or temporary numbness or weakness in and around the affected area.
Mohs surgery requires extensive training and skill. The surgeon needs to accurately map out the tumor and analyze each layer of tissue removed during surgery. Working with a highly experienced dermatologist is important. They should be fellowship-trained and certified by the American College of Mohs Surgery. Trained physicians are not only experts in reading slides, but also in closing the wound as beautifully as possible. When choosing a surgeon, ask them about their level of training, if they are fellowship-trained, and the number of procedures like yours that they have personally performed.
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What Is A Mohs Procedure
When it comes to skin cancer treatments, it is always best to look into all viable treatments that offer a strong chance at recovery with the least invasive method. If you or a loved one is diagnosed with skin cancer, you may want to know more about the Mohs procedure. Ultimately, it is one of the most promising ways to cure many types of skin cancers without undergoing chemotherapy, radiation, or highly invasive surgical procedures. This procedure is a relatively simple, fast, safe, and effective way to remove a cancerous skin tumor that does not require a long time to heal up.
Mohs Vs Excision Surgery
Then came a basal cell area that was in a spot where Ive not previously had skin cancer. It was just under my nose, and the diagnosis was an infiltrating basal cell carcinoma. My dermatologist and I were both in agreement that she would not do this surgery, as it was on my face. She wanted me to have Mohs surgery. I wanted an excisional surgery because thats what I knew. We compromised she referred me to two plastic surgeons so I could get their opinion, and I would then meet with a Mohs surgeon if necessary.
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How You Have It
Your doctor draws around the skin cancer with a pen.
Youre awake for your surgery. But you have an injection of medicine to numb the area .
The doctor removes the cancer tissue and a small amount of healthy tissue . They put a dressing on the wound and ask you to wait.
The doctor sends the tissue to the laboratory and a specialist doctor looks at it under a microscope. They look to see if any cancer might be left. You can wait for up to an hour to get these results.
If the cancer is still there, the doctor injects more local anaesthetic in the area and removes more tissue. You then wait again.
Your doctor will continue to remove more tissue until they are sure all the cancer has gone and there is a surrounding area of healthy cells.
Your doctor might leave your wound to heal without stitches. Youll have a dressing on top to protect it. Or they might use stitches to close the wound. In some cases, another surgeon repairs your wound. This might be on the same day or very soon afterwards.
How Mohs Surgery Works
Sometimes known as Mohs micrographic surgery, the technique was invented in the 1930s by Dr. Frederic Mohs at the University of Wisconsin, but it didnt develop into a mainstream treatment until practitioners such as NYU dermatologist Perry Robins, MD, refined the technique and spread the word about it in the 1970s and 1980s. The use of Mohs surgery has especially been growing in the past 15 years, above all for skin cancers in the head and neck region.2-5
The most obvious difference between Mohs surgery and routine excisional surgery is that Mohs is done in stages while you wait for lab results, which are obtained immediately on site, rather than the tissue sample being sent to a lab for results days later.
A surgeon specially trained in Mohs surgery, pathology and reconstructive surgery first may draw some marks around the lesion with ink to guide the treatment, then injects a local anesthesia. Using a scalpel, the doctor removes the thinnest possible layer of visible cancerous tissue. A nurse or assistant bandages your wound and shows you to a waiting area.
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What Is The Difference Between Mohs And Standard Surgery
Mohs surgery examines 100% of the margin of the excised tissues. This is accomplished by a special method of tissue orientation during processing. Excision using typical “frozen sections” prepared in a hospital, and standard surgical excision in the office which uses paraffin embedded section examination merely sample the edge of the excised tissues. These alternative forms of tissue examination provide only a tiny sampling of the tumor margin.
Only Mohs surgery utilizes a single physician in two capacities: as the surgeon, and as the pathologist. By knowing exactly how the tissue was removed, oriented, divided, and mapped, the Mohs surgeon can most accurately analyze the excised tissues.
Surgery For Basal And Squamous Cell Skin Cancers
Surgery is a common treatment for basal cell and squamous cell skin cancers. Different surgical techniques can be used. The options depend on the type of skin cancer, how large the cancer is, where it is on the body, and other factors. Most often the surgery can be done in a doctors office or hospital clinic using a local anesthetic . For skin cancers with a high risk of spreading, surgery sometimes will be followed by other treatments, such as radiation or chemotherapy.
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When You Have Been Diagnosed With Skin Cancer One Of The Most Effective Treatment Options Is Mohs Micrographic Surgery Call Us At 734
The cure rate for Mohs micrographic surgery is the highest of all treatments for many skin cancers – often approaching 99% even if other forms of treatment have failed. This procedure – the most exact and precise method of tumor removal – minimizes the chance of regrowth and lessens the potential for scarring or disfigurement by conserving as much normal tissue as possible.
Surgery For Complex Skin Cancer
Some people with skin cancer may require specialists. That often happens when skin cancer has grown deeply or in a sensitive area of the body, such as the eye or near critical nerves.
The most effective way to treat advanced basal cell, squamous cell, and other unusual, aggressive skin cancers is to receive care at a comprehensive cancer center that focuses on treating the person as a whole and maintaining quality of life. Thats why we recommend that patients with these conditions consider receiving care from our Multidisciplinary Skin Cancer Management Program.
This program brings together experts in dermatology, Mohs surgery, head and neck surgery, surgical oncology, plastic and reconstructive surgery, medical oncology, pathology, radiation oncology, radiology, genetics, dentistry, nursing, and more.
Many of our patients are able to receive several expert consultations on a single day and in one place to make things more convenient and efficient.
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What Makes Yale Medicine’s Approach To Moh’s Micrographic Surgery Unique
We are one of the oldest academic Mohs surgery programs in the country, says Dr. Leffell, who has trained 22 fellows in Mohs surgery and reconstruction. We have treated thousands of cases over the yearswell over 100,000 cases in total.
As a training program for residents and fellows, you have the benefit of being seen in a continual learning environment and can be assured of the highest degree of training and advances. While striving to put the patient first in everything we do, we are not only educating the next generation of skin cancer experts but conducting research into the genetics of skin cancer, new therapies and technologies, he says. In fact, the basal cell cancer gene was discovered in 1996 by a collaboration that involved Dr. Leffell and his team.
At Yale Medicine, the patient comes first. That’s evident from the designated Mohs patient lounge area and the open, proactive conversations between doctor and patient about how to deal with the cancerfrom removal to post-op management. Communication is one of the most important factors in patient care, and all our staff are focused on that, Dr. Leffell says.
Our dermatology practice consistently scores in the 98th to 99th percentile in patient satisfaction surveys, which are measured against all practices nationwide.
Can You Drive Home After Mohs Surgery
Mohs surgery usually is done on an outpatient basis and uses localized anesthetic to eliminate any pain. A patient likely would not undergo any disorienting medication that would render them incapable of driving immediately after undergoing surgery. Mohs surgery recovery is generally very quick due to the highly localized and generally non-invasive nature. Barring any disorienting medication, such as pain medication that might be administered, and depending on the location of the surgery, you can drive home after. Like any surgical procedure, it is best to have someone else handle the driving due to potential stress and other distractions.
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When Do You Have It
Mohs micrographic surgery is most useful for:
- basal cell cancers that have come back after removal or have not been completely removed
- basal cell cancers that have grown in an area that has had surgery or radiotherapy before
- basal cell cancers that are growing into surrounding skin tissue
- large skin cancers where removing as little of the healthy skin tissue as possible can mean a smaller scar
- cancers in areas where it’s important to remove as little tissue as possible: for example, near the eyes, lips, ears or nose
- some rare skin cancers
Using Mohs Surgery To Treat Skin Cancer
If you are reading this, you or someone you know was probably diagnosed with skin cancer, and it has been recommended by a doctor that Mohs surgery is their best option. According to the Skin Cancer Foundation, more than 5 million cases of basal cell and squamous cell are treated here in the U.S. every year. Many dermatologist choose Mohs surgery because it offers the highest cure rate available for many types of skin cancer.
Dermatologist examines a mole of female patient in clinic
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Some Mohs Surgery Steps
Arielle Kauvar, MD, examines a cancerous area on the side of the patients nose.
Before starting the surgery, Dr. Kauvar injects a local anesthetic.
Dr. Kauvar removes the first layer of cancerous tissue.
In the lab, the surgeon examines slides with sections of the removed tissue.
Next, she marks a map of where cancer cells remain before round two of surgery.
Bandaged, the patient waits for the lab results before another round of surgery. It takes time to get the all-clear, but its worth it!
The team repeats this whole process until the margins of the last excised tissue sample are clear and cancer-free. At that point, the doctor usually closes the wound with stitches. In some cases, a large wound on the face or around a joint may need reconstruction with a skin flap or a skin graft. Mohs surgeons are trained in these techniques, though in some cases, a plastic surgeon may do the reconstruction or closure. After that, the wound is bandaged, youre given instructions on how to take care of the incision and youre done.
Surgery For Lentigo Maligna Melanoma
Lentigo maligna melanoma is a rare form of melanoma. It most frequently develops on the face and neck. Our dermatologic surgeons are among the most experienced in the world at treating this condition. We wrote the first and only book on how to manage the disease and are highly skilled in surgical approaches to remove it.
Noninvasive imaging called confocal microscopy maps out the skin that needs to be removed. Our team works closely with a pathology team focused on skin cancer. We make sure that you get the right diagnosis and that we put together the best possible treatment plan for you.
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A Closer Look At Radiotherapy Vs Mohs Surgery
In addition to understanding the difference between how radiotherapy and Mohs surgery are performed, patients should know how each treatment option may affect their daily life. Because Mohs surgery requires cutting away layers of skin, patients are left with a wound that eventually leaves a scar. In more severe cases, plastic surgery or skin grafting may be necessary to help the wound heal properly. Mohs surgery also may require patients to stop the usage of certain medications before surgery, and they may need to take antibiotics post-surgery.
Use the table below for a clearer picture of how radiotherapy vs. Mohs surgery can impact your life:
| Mohs Surgery |
Preparing For Your Surgery
You will need to be off for the entire day of your surgery, as we cannot predict how long you will be with us on that day.
What to Bring:
Please bring a book or a tablet to help pass the time. We have Wi-Fi available. Wear comfortable clothes that can be easily removed without going over your head such as a button-down shirt. We will provide light snacks throughout the day.
Medications:
Only stop your medications if instructed by your primary care doctor or cardiologist. If you take aspirin for prevention and have NO history of heart attack or stroke, please stop your aspirin ten days before surgery. If you take ibuprofen or naproxen, please limit your use for two weeks prior to surgery. Please stop the following oral supplements one week prior to surgery: fish oil, garlic supplements, ginkgo, and vitamin E.
If you have been told by your doctor to take antibiotics before procedures and you have a history of artificial implants, heart valves, heart murmurs, or other conditions, please call our office prior to surgery so we can help you plan accordingly.
Day of Surgery:
Please eat breakfast and take your regular medications. You will be awake for the procedure so it is not necessary to fast.
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