Mohs surgery, named for Dr. Frederic Mohs, is a technique for evaluating the margins of a skin cancer during surgery. Mohs allows for the removal of skin cancers while sparing adjacent uninvolved skin. Mohs is presently the most effective treatment for most skin cancers.
There are many types of skin cancer and the three most common are basal cell carcinoma, squamous cell carcinoma and melanoma. Basal cell carcinoma is the most frequent type of skin cancer and although it does not usually go to other parts of the body, it can destroy adjacent structures. Squamous cell carcinoma is the next most frequent type of cancer and it can rarely metastasize. Melanoma, on the other hand, has the ability to metastasize. The frequency with which a melanoma spreads is usually correlated with the thickness of the tumor. While melanoma can go to other parts of the body, it is usually curable when it is detected and treated early.
Mohs surgery is useful in treating basal cell carcinomas and squamous cell carcinomas. When these cancers are located on the nose or ears or around the eyes, this is the treatment of choice. Mohs may also be indicated for very large skin cancers, skin cancers that are long standing or that have returned after previous treatment. Certain pathologic types of skin cancer are also indications for performing Mohs. Finally, there are skin cancers with poorly defined borders that are best treated with Mohs surgery.
Mohs surgery is performed in an office setting using local anesthetic. Tissue is removed and oriented with colored dyes. This color-coding allows Dr. Kenneth Beer to determine where the top, bottom, left and right sides of the specimen are.
After preparation in the laboratory, the periphery and underside of the specimen are evaluated. If cancer is seen at the margins of the specimen, more skin is removed from the patient at a site corresponding to the involved area. The tissue is again color coded and examined under the microscope. The process is repeated until no tumor is seen in any margin. This requires two or three stages in most cases.
Although the time spent performing the surgery is only about 15 minutes per stage, the entire Mohs procedure can take between two to four hours. Most of this time is spent freezing the tissue and preparing slides. Tissue preparation takes between 30 and 60 minutes per stage. I recommend that you bring a book, a sweater and a snack on the day of the surgery.
Mohs surgery offers many advantages in treating skin cancer. It allows Dr. Kenneth Beer to trace the cancer to its roots. This results in the removal of as little normal skin as possible while having the highest cure rate available.
Only dermatologists perform Mohs surgery. Some of these dermatologists have completed fellowships in Mohs surgery while many others are trained in the procedure during their residency or from colleagues experienced in the procedure. Dr. Kenneth Beer trained in Mohs during his residency and subsequent fellowship in dermatopathology (pathology of the skin). He is board certified in dermatology and dermatopathology and his dermatopathology training makes him uniquely qualified to interpret skin pathology specimens.
Avoid taking aspirin or aspirin containing compounds for a week prior to surgery. If you are on coumadin, please discuss this with Dr. Kenneth Beer several a week before the surgery. Try to get a good nights rest and have a light breakfast before coming to the office.
In many instances, Dr. Kenneth Beer is able to repair your skin on the day of your surgery (usually in the afternoon). In some cases, the repair is performed the following day or Dr. Kenneth Beer will refer you to a plastic surgeon. Finally, there are some cases where letting the defect heal by itself will produce the least visible scar.
Most patients do not have significant discomfort following the procedure. If you experience discomfort, try taking Tylenol or, if the pain is unmanageable, call Dr. Kenneth Beer.
If you experience any bleeding following the procedure, remove the dressing except the layer touching the skin and apply pressure to this for 15 minutes. If this does not stop the bleeding, call Dr. Kenneth Beer or proceed to the nearest emergency room.
After the wound has healed, it is important to be seen at three, six and twelve months. Thereafter, either Dr. Kenneth Beer or your referring physician should see you at least once a year. This will allow any recurrence to be detected early. In addition, after one has had skin cancer, one has a higher risk of developing new skin cancers. If you notice any suspicious lesions prior to a follow up visit, make an appointment to see Dr. Kenneth Beer or your referring physician.