Skin Cancer

Mohs Skin Cancer Surgery

Mohs Micrographic Surgery

What is Mohs Surgery?

The Effectiveness of Mohs

Mohs Micrographic Surgery is an effective and precise method for treating basal cell skin cancers, squamous cell skin cancers, certain melanomas and other more rare skin tumors. Because the Mohs Micrographic Surgery process involves a systematic microscopic search that traces skin cancers down to their roots, it offers the highest chance for complete removal of the tumor while sparing the normal tissue surrounding it.

Clinical studies conducted at various national and international medical institutions – including the Mayo Clinic, the University of Miami School of Medicine and Royal Perth Hospital in Australia – demonstrate that Mohs surgery provides five-year cure rates up to 99 percent for new cancers, and 95 percent for recurrent cancers.

When is Mohs surgery recommended?

Mohs Micrographic Surgery is primarily used to treat skin cancers on cosmetically sensitive or vital areas where tissue preservation, cosmetic appearance and functional outcome are of the utmost importance.

This highly technical surgery is usually reserved for certain circumstances, specifically:

• To remove skin cancer near cosmetically sensitive areas, including the face, nose, lips, eyelids, ears, fingers, toes and genitals.
• When the tumor is large and has indistinct margins.
• When there is a high risk of recurrence.
• To remove a recurrent skin cancer.
• When the tumor is located near scar tissue.
• When the tumor is aggressive and fast growing.
• When the patient is immunosuppressed.

How is Mohs surgery performed?

Mohs surgery is a highly specialized and precise procedure performed by fellowship-trained surgeons with advanced training who act as both surgeon and pathologist. At Clearview Dermatology, Mohs surgery is performed in an outpatient setting, at our state-of-the-art dermatology office in Arvada, CO, under local anesthesia.

The area to be treated is numbed and the lesion is removed one layer at a time. It is then prepared with colored dyes and is examined under a microscope by Dr. Overman to identify and map the microscopic roots of the cancer. The procedure is repeated until no tumor cells can be detected under microscopic examination. The wound is then repaired to restore function and cosmesis. After the surgery you will wear a bandage until the sutures are removed 7-14 days later. While the site typically heals a great deal in the first few weeks, final results will not be seen until 12 months after surgery as the scar continues to improve and heal with time.

The procedure typically takes about 3-5 hours in our outpatient office. Most of the time is spent creating and reading the slides to determine if your cancer has been completely removed. While it can take several hours to ensure the tumor is removed, this ensures the tumor is completely gone and as much surrounding tissue is preserved as possible. The result is a significantly better cosmetic result with a much lower chance of cancer recurrence.

Once the tumor has been completely removed, the decision is made regarding the best approach to repairing the wound. Sometimes the wound is allowed to heal naturally, known as healing by “secondary intention”, other times a wound in sutured together in a linear fashion. Some wounds require local rearrangement of tissue known as a “flap” or transfer of tissue from another site into the wound known as a “skin graft”. Dr. Overman’s extensive training and experience in plastic and reconstructive surgery allows him to choose the best option to restore his patients’ cosmetic appearance and function.

Side effects include swelling, bruising, tenderness and tightness at the site while the tissue heals. Some minor bleeding can be expected and is normal. Complete healing can take up to 12 months depending on the extent of surgery. Risks are the same as with any surgical procedure.

Cost Effectiveness

As the incidence of skin cancer soars, greater focus is currently being placed on the cost effectiveness of treatment. Over the past decade, multiple studies have been conducted to calculate and compare the costs of Mohs Micrographic Surgery with those of traditional surgical methods. These studies have repeatedly shown that Mohs surgery is no more costly than standard excision and less expensive than radiation therapy or excision in a hospital or ambulatory surgery center. Because the process of Mohs Surgery minimizes the risk of recurrence, it reduces and frequently eliminates the costs of larger, more serious surgery for recurrent skin cancers. It also avoids the inherent risks and costs of undergoing general anesthesia.

What are the disadvantages of Mohs surgery?

The Mohs technique is extremely labor-intensive and requires a highly qualified fellowship-trained surgeon with expertise in high-risk skin cancers, as well as an experienced histotechnician with specific training in Mohs frozen tissue processing, a fully certified Mohs laboratory, and well-trained nursing staff. At Clearview Dermatology, we strive to be world-class at every level of this highly technical process.

The technique is also a time-consuming process that requires patient cooperation and understanding. A typical procedure can last three to five hours, and complicated cases can take even longer. We recommend bringing reading materials, work, laptops or other items to keep yourself occupied during the day. We have complimentary WIFI for our patients. It is also a good idea to bring a snack, although we are happy to provide one if you forget.