About Mohs Surgery

 WHAT IS MOHS SURGERY

Mohs Surgery is a highly effective technique used for the removal of skin cancer. It has the highest reported cure rate for nonmelanoma skin cancer (99% effective) . The procedure was developed in the 1930s by Dr. Frederick Mohs, a dermatologic surgeon from the University of Wisconsin. Mohs surgery is reserved for skin cancers on the face, recurrent skin cancers, large skin cancers, fast growing skin cancers and cancers which have been neglected.

WHAT ARE THE 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. Dr Harvey  is a recognized  Fellow of the American Society for Mohs Surgery and has performed over a thousand cases of this type of surgery.

HOW IS MOHS SURGERY PERFORMED?

Mohs Surgery is performed in our state of the art laboratory and Medicare certified surgery center. This will optimize the safety of your procedure and ensure that it is carried out in a comfortable and clean environment. The process begins as the skin is numbed with a local anesthetic. The visible skin cancer is then removed with an additional thin layer of normal tissue. A detailed Mohs map is subsequently drawn out with a skin-marking device. The specimen is color-coded and the tissue is frozen by our lab technician. Thin slices of the removed skin are placed on a slide. This process may take from 20 minutes to 90 minutes and is the most time consuming part of the surgery.   


Fig 1. Tissue is cut using frozen sections . 

Our surgeons will then examine the skin cancer under the
microscope. All microscopic roots of the cancer are pinpointed. If skin cancer is not seen at the base or edges, we will cosmetically repair the area. If skin cancer cells are found, then additional layers of skin are removed where the skin cancer is present. This process continues in stages until the tumor has been entirely removed.                                          
 

Fig 2. Mohs Surgeon evaluates  the
tumor margins under microscope.                                                                                                                                                                                                                                         

HOW LONG DOES MOHS SURGERY TAKE?

Typically, most cases are completed in 1 to 4 hours. You are awake during the procedure as the operation is carried out using local anesthesia. Please make arrangements to stay the entire morning or afternoon with us. Mohs surgery is performed with the patient awake as an outpatient procedure

Fig 3. Once margins are clear, the surgical
closure is initiated using plastic surgical techniques.

WILL THE PROCEDURE LEAVE A SCAR?

Yes. The Mohs technique, however, allows for the smallest surgical scar possible.

WHAT HAPPENS AFTER MOHS SURGERY IS COMPLETED?

Our surgeons will discuss with you what type of wound closure would be best, e.g., flap, graft, linear repair, etc. Sometimes it is best to leave the wound open to naturally heal If the tumor is very aggressive, low-grade radiation treatments are sometimes used along with Mohs surgery to enhance the effectiveness of the procedure. Sutures are removed in 7 to 14 days.

WILL I HAVE ANY PAIN, BRUISING, OR SWELLING?
Most patients do not complain of significant pain. If there is discomfort, Tylenol 500 mg is all that is usually necessary for relief. Stronger pain medications can be prescribed when needed. Bruising or swelling usually resolves within 7 to 10 days.

WILL MY INSURANCE COVER THE COST OF THIS PROCEDURE?

Yes, in most instances, your insurance will cover the cost of this procedure. A facility fee will be charged to your insurance carrier if your case requires a complex repair, flap or skin graft to close the wound. Please check with your insurance carrier regarding coverage, deductibles and co-pay information. If you still need help, you may contact our billing department at 285-7546 ext 203 or email robert@pvderm.com.

If you have any questions about your Mohs Surgery, please call  Ponte Vedra Dermatology & Aesthetic Surgery at (904) 285-7546 ext 210 or email amy@pvderm.com.