About Mohs Surgery
Cancer is a scary word, but for women and men who are diagnosed with certain types of skin cancer, Mohs surgery is one of the most effective treatments. Mohs surgery is a state-of-the-art specialized procedure that carefully and precisely removes skin cancer cells. The aim of the procedure is to completely remove the skin cancer while damaging or removing as little healthy tissue as possible.
What appears on the surface of the skin can often be the "tip of the iceberg." A poorly definted tumor can blend in to the surrounding areas.
The tissue is processed in the office and applied to slides so the tissue pathology can be reviewed under the microscope and 100% of the margin can be examined.
The surgical technique is used to treat squamous and basal cell carcinomas and a few other less common types of tumors. Dr. Aradhna Saxena of the Dermatology and Skin Cancer Institute is a board-certified dermatologist, fellowship-trained Mohs surgeon, and skin cancer specialist. She will begin this procedure by slowly and carefully removing the cancerous tissue one layer at a time. After each and every layer, she will examine the cellular makeup of the skin tissue to determine if any cancer remains.
Mohs Surgery Reviews
Mohs Surgery Ideal Candidates
The Mohs surgery technique is typically used to treat the two most common forms of skin cancer, squamous cell carcinoma and basal cell carcinoma, as well as a few other skin cancer subtypes. If you are suffering from melanoma or another form of rare skin cancer, a consultation will help determine if you are a candidate for Mohs surgery or excisional surgery. In addition to the specific type of skin cancer you have, there are also other qualifying criteria that make you a good candidate for Mohs surgery.
Mohs surgery is the best option if your cancer has a high risk of returning or if it has already returned after previous treatment. It is the best method for removing cancer in sensitive areas, such as the eyes, ears, mouth, or nose, though the surgery is not limited to those areas. Skin cancer lesions that are large, aggressive, and have blurred or undefined borders are also best treated with Mohs surgery.
Mohs Surgery Surgical Technique
Dr. Saxena performs Mohs surgery with local anesthetic. The first step of a Mohs surgery is to excise the entire visible skin cancer lesion, along with a tiny layer of surrounding skin cells. This tissue is then cut into sections, which are inked to maintain proper orientation.
The removed tissue is then frozen, and extremely thin layers are shaved off its sides and bottom for examination under a microscope. Any cancerous cells that Dr. Saxena finds will be marked on the Mohs map in the correct spot. Dr. Saxena will then use the map to determine where any remaining cancerous tissue needs to be removed. She will repeat this process until all detectable skin cancer is removed. So, to summarize, Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all "roots" and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.
The length of Mohs surgery depends on several things, including how many layers of tissue need to be excised. After your procedure, Dr. Saxena will discuss the options for healing, the most common of which is a surgical repair requiring sutures.
What to Expect with Mohs Surgery
A Mohs procedure is not a simple solution, but with a skilled team and the right amount of anesthesia, most patients report only minor discomfort. Mohs surgery is usually performed as an outpatient procedure, with patients able to drive themselves home afterward. Although the site will be heavily bandaged, it is possible to resume routine, non-strenuous activities the next day. This rules out any strenuous exercise or heavy activities for up to 1 – 2 weeks. If sutures were utilized, they will be removed within 6 – 14 days. Scarring will vary for each procedure. The success rate for removing all cancerous tissue from the site is very high, ranging from 97% to 99%.
During the surgery, tiny nerve endings are cut, which may produce numbness in an around the surgical area. Rarely, some patients experience intermittent itching or shooting pain in the surgical area. These symptoms usually resolve in a few months and are rarely permanent.
Mohs Surgery Frequently Asked Questions
What is the success rate?
Mohs surgery is extremely successful in the elimination of non-melanoma skin cancer. The achievement rates of eliminating all the cancerous tissue when treating basal cell carcinoma and squamous cell carcinoma approach 99%.
Is it painful?
Most patients feel very little pain or discomfort during surgery because anesthetic is used. Pain medication is rarely necessary during recovery, either. If you do experience any pain, Dr. Saxena will typically recommend an over-the-counter painkiller.
Will I have a scar?
Scarring varies on a case-by-case and patient-by-patient basis. Larger treatment areas have a higher potential for scarring. However, Dr. Saxena always does everything possible to minimize scarring. Once you have healed, she may suggest a scar revision surgery to help reduce the look of any scars.
Will I need more than one treatment?
Every patient is unique and presents his or her own personal needs. Very few patients need a second surgery, but Dr. Saxena will discuss your personal situation with you during your consultation.
Is my surgeon fellowship-trained?
Yes, Dr. Saxena completed 1-year of additional training after her dermatology residency to focus only on skin surgery and skin cancer histopathology. Dr. Saxena's fellowship was accredited by the American College of Mohs surgery, the organization founded by Dr. Frederic Mohs in 1967.
What does Mohs stand for?
Mohs surgery was named after Dr. Frederic Mohs, a surgeon who pioneered the treatment at The University of Wisconsin in the 1930s. Initially, Dr. Mohs removed tumors by applying a chemical, zinc oxide paste, to the tumor. The tissue was then removed and processed. The technique was performed over a few days. As the process evolved, surgeons eliminated the chemical treatment and removed fresh tissue which could be processed within a few hours and allowed the surgery and reconstruction to be performed in the same day.
Plan Your Procedure
Seek Superior Care
When facing a skin cancer diagnosis, it is important to do your research and find a trained Mohs surgeon who is a good fit for your expectations and needs. Success rates of the procedure are directly related to your doctor's skill and experience. To learn more about the experience, training, and personal success rates of Dr. Saxena, call the Dermatology and Skin Cancer Institute now and schedule a consultation. Dr. Saxena performs Mohs surgery at her Fort Washington and Lansdale, PA offices.