What is MOHS Surgery?
This cutting-edge treatment requires highly specialized physicians such as Dr. Patel who can serve as surgeon, pathologist and reconstructive surgeon.
The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur. A surgery starts with the American College of Mohs Surgery (ACMS) specialist examining the visible lesion and planning what tissue to remove. The patient then receives local anesthesia, and the Mohs surgery begins.
The surgeon removes the visible portion of the tumor using careful surgical techniques.
The ACMS surgeon next removes a deeper layer of skin and divides it into sections. With the help of technicians, the surgeon then color-codes each of these sections with dyes and makes reference marks on the skin to show the source of the sections. A map of the surgical site is then drawn to track exactly where each small portion of tissue originated.
In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer.
If the surgeon finds cancer cells under the microscope, he or she marks their location on the “map” and returns to the patient to remove another deeper layer of skin — but only from precisely where the cancer cells originated. This method ensures that the Mohs surgery results in the smallest scar possible.
The removal process stops when there is no longer any evidence of cancer in the surgical site. Because Mohs surgey removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.
At this point, the surgeon discusses reconstruction options, should they be required, and then post-operative care. Mohs surgery recovery tends to be easily manageable because of the use of local anesthesia and the careful surgical techniques.
Why does my skin cancer need MOHS Surgery?
Mohs surgery has the highest cure rate (up to 99%) for nonmelanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma. It is appropriate for most skin cancers and especially suitable for skin cancer that:
• Is in an area where it is important to preserve healthy tissue for best functional and cosmetic results
• Was treated previously and has come back
• Is located near scar tissue
• Is large, greater than 1 cm in diameter
• Does not have clearly defined edges
• Is growing rapidly or uncontrollably
• Is of an aggressive subtype (i.e., sclerosing or infiltrating basal cell carcinoma)
• Develop in immunocompromised patients
What is the ACMS Difference?
Fellowship training programs are designed to impart experience and judgment into each graduate. By design, these programs are comprehensive and rigorous because skin cancer itself occurs in a diversity of forms, degrees, and areas of the body. To complete an ACMS-approved fellowship, a physician must:
- Participate in a minimum of 500 Mohs surgery cases
- Learn to accurately interpret slides of tissue samples that have been removed during Mohs surgery
- Perform a wide breadth of reconstructions, ranging from simple closures to complicated multi-step repairs
Because fellows-in-training undergo training over months, they gain a breadth of exposure – under the guidance of a qualified Mohs surgeon – that includes rare tumor pathology, difficult tumor locations, and complex wound reconstruction. This fellowship training provides a depth of experience unmatched by other Mohs programs
Once the cancer has been removed, reconstruction for optimizing the final functional and cosmetic result becomes the highest priority. Dr. Patel will explain options for repair of the wound, including natural healing, linear closure, or using a skin flap or graft and will be completed in our office typically in the same visit. Generally, post-surgical scar improves with time. The team at True Dermatology are experts in reconstruction and aesthetics and are available for you throughout the healing process to discuss any concerns that may arise.