Our Fellowship-trained Mohs physicians offer Mohs Micrographic Surgery for the treatment of high-risk skin cancer.
Finding skin cancer is the first step towards curing it. Mohs micrographic surgery is the next step. Skin cancers that occur in high-risk areas such as around the eyes, ears, nose and lips, or which have recurred after previous treatment are more effectively treated using Mohs Micrographic Surgery.
Mohs Micrographic Surgery
Mohs surgery is a highly specialized treatment developed by Dr. Frederic Mohs and is a method for treating skin cancer that removes the diseased area with continuous microscopic control.
Not all tumors grow as perfect spheres. What is visible on the surface of the skin may be only the tip of the tumor that exists underneath the skin. There are several different modes of tumor growth that are best treated using the Mohs technique.
No Hospitalization Needed with Mohs
The procedure is performed entirely in our outpatient surgical suites. The tissue is examined in the office. The high cure rate means fewer return visits and less need for additional treatment. And, since the area around the tumor is numbed with local anesthetic, you lose no time in recovery.
Frequently Asked Questions about Mohs Micrographic Surgery
What is skin cancer?
Skin cancer is a term for a variety of growths on the skin. Other terms are skin tumor and skin malignancy.
Are there different types of skin cancer?
Yes. The three most common types of skin cancer include:
- Basal Cell skin cancer or Basal Cell Carcinoma (BCC) are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the outermost layer of the skin. BCC often looks like open sores, red patches, pink growths, shiny bumps or scars.
- Squamous Cell skin cancer or Squamous Cell Carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers. SCC often looks like red scaly patches, open sores, elevated growths with a central depression, or warts that may crust or bleed.
- Melanoma is another type of skin cancer and considered to be the most dangerous. These cancerous growths develop when unrepaired DNA damage to skin cells triggers mutations that lead the skin cells to multiply rapidly and form malignant tumors. These tumors originate in the basal layer of the skin. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white.
Are skin cancers life-threatening?
The two most common types of skin cancer, basal cell carcinoma and squamous cell carcinoma, are rarely life threatening. These tumors replace normal surrounding tissue and do not spread to other areas. The third most common skin cancer, malignant melanoma, can be life threatening if treated late. When discovered and treated early, malignant melanoma is curable. Basal cell carcinomas and squamous cell carcinomas never “turn into” malignant melanoma.
How is skin cancer such as basal cell carcinoma or squamous cell carcinoma treated?
There are several effective treatments for these tumors. Therapies such as freezing with liquid nitrogen, burning with electric current, surgery and radiation therapy are successful. However, for tumors that have recurred following treatment or for tumors in difficult-to-treat sites, a technique of skin cancer treatment known as Mohs surgery offers the best chance for total removal. It is this type of surgery for which your doctor has referred you to our office.
Are there prevention and early detection measures for skin cancer?
Look for noticeable changes in your skin including:
- Large brown spots with darker speckles located anywhere on the body
- Dark lesions on the palms of the hands and soles of the feet, fingertips, toes, mouth, nose or genitalia
- Translucent, pearly and dome-shaped growths
- Existing moles that begin to grow, itch or bleed
- Brown or black streaks under the nails
- A sore that repeatedly heals and re-opens
- Clusters of slow-growing, scaly lesions that are pink or red
- If any of these conditions occur, please make an appointment to see one of our dermatologists right away.
The American Academy of Dermatology has developed the following ABCDE guide for assessing whether or not a mole or other lesion may become cancerous.
- Asymmetry: Half of the mole does not match the other half in size, shape or color
- Border: The edges of moles are irregular, scalloped or poorly defined
Color: The mole is not the same color throughout
- Diameter: The mole is usually greater than six millimeters when diagnosed, but may also be smaller
- Evolving: A mole or skin lesion that is different from the rest, or changes in size, shape or color
If any of these conditions occur, please make an appointment to see one of our dermatologists right away. The doctor may do a biopsy of the mole to determine whether it is cancerous.
Roughly 90% of non-melanoma cancers are attributable to ultraviolet radiation from the sun. That’s why prevention involves:
- Staying out of the sun during peak hours, between 10 a.m. and 4 p.m.
- Covering up the arms and legs with protective clothing
- Wearing a wide-brimmed hat and sunglasses
- Using sunscreens year round with an SPF of 15 or greater and sunblocks that work on both UVA and UVB rays and use the term “broad spectrum”
- Checking your skin monthly and contacting your dermatologist if you notice any changes
- Getting regular skin examinations — it is advised that adults over 40 get an annual exam with a dermatologist
What does "Mohs" stand for?
Dr. Frederic Mohs developed this technique about 60 years ago. The procedure has been modified and refined over the years. Practitioners of the technique have kept Dr. Mohs’ name in respect for his contribution. Mohs surgery has other names including Mohs chemosurgery, Mohs microscopically controlled surgery and Mohs micrographic surgery.
What is Mohs Surgery?
Mohs surgery is a technique for skin cancer treatment in which the cancer is surgically excised, and the specimen is processed immediately so that the surgeon can examine the tissue under the microscope. If cancer has not been completely removed, then additional tissue is excised and reviewed again under the microscope. Once the skin cancer is totally removed, the wound is closed.
How are melanomas treated?
Melanoma is cancer that is treated surgically. When the melanoma is thin (has not penetrated deeply into the skin), surgical removal is usually the cure.
How is Mohs surgery like other surgery?
The Mohs surgeon uses conventional surgical instruments and removes malignant tissue during surgery.
How is Mohs surgery different from other types of surgery?
The difference is what happens to the tissue after it is removed. After complete removal of the obvious tumor, the surgeon removes a thin layer of normal appearing skin surrounding the tumor. A map is made of the specimen. It is then processed in the laboratory for approximately one hour. The surgeon then examines the specimen under the microscope. If cancer is present in the specimen, the Mohs surgeon marks its location on the map and then returns to the patient and removes more tissue in that area. This step is repeated, if necessary, until the tumor is completely removed.
What are the advantages of Mohs surgery?
There are two primary advantages. First, by using the microscopic examination of the tissue as a guide, the Mohs surgeon is better able to remove all of the skin cancer. Secondly, by carefully mapping out the tumor, the surgeon removes cancerous tissue and leaves behind as much normal skin as possible.
Other advantages of Mohs include:
- Cost effective compared to other surgical options
- Highest cure rate of any existing procedure
- Lowest functional and cosmetic morbidity of any procedure
- Optimal skin tissue preservation
- Single-day outpatient procedure with local anesthesia
How large of a scar will I have from the surgery?
The size of the scar depends on the size of the tumor. It is often difficult to predict the size of the tumor before surgery.
Will I have stitches following the surgery?
There are three main ways your surgical wound may be handled:
#1 Direct closure of the wound: In most instances, surgical wounds are sutured (sewn) closed.
#2 Skin graft: In some instances, it is necessary to remove the skin from some other site and graft it over the wound.
#3 Second intention healing: The body has an excellent capacity to heal open wounds. This healing period is approximately 3-6 weeks depending on the size of the wound. It requires regular wound care.
In addition to wound size and location, the surgeon considers other factors to determine how your wound will be handled. This will be fully discussed with you on the day of surgery.
Will I be put to sleep for the surgery?
No. The surgery is well tolerated with local anesthesia. Because the surgery may be time-consuming, the risk of prolonged general anesthesia is avoided.
How long will the surgery last?
The length of surgery depends on the extent of the tumor. Often surgery lasts half a day or longer. Much of the time is spent waiting for tissue to be processed. Bring reading materials or mobile device entertainment with you to help pass the time.
What if I live far away from The Skin Surgery Center?
If you have to travel a great distance, you may want to spend the night before surgery in the surrounding area. There are several moderately priced motels nearby. A list of these is available upon request.
Disclaimer: Families and patients traveling from out of town for treatment can find affordable lodging in a caring environment at the SECU Family House on the Richard J. Reynolds III & Marie M. Reynolds Campus.
Should I bring someone with me?
We highly encourage you to bring someone with you. The nurses will give you wound care instructions after your surgery, and since some sites require someone else to perform the wound care, they can go over that with them as well and answer any questions. Even with minor procedures, some patients may feel anxious or nervous. We can give you something to help you relax, but this would require that someone else comes with you and drives. Due to the limited space in the waiting room, please try to limit family or friends to 1-2 persons. This will ensure your comfort as well as the comfort of other patients who will also be having surgery the same day.
What should I wear?
Men or women should wear a shirt that buttons down the front and slacks. A skirt for women can also be worn instead of slacks.
Should I eat breakfast before surgery?
Yes. Breakfast is recommended.
Should I take my regular medications on the morning of the surgery?
Yes. Take your regular medications as they have been prescribed.
Are there any medications I should avoid before surgery?
Will my activity be limited after surgery?
Possible hindrances depending on your specific situation will be discussed with you on the day of your surgery.
What are the potential complications of surgery?
Bleeding and infection are the two primary complications. Both of these are uncommon. We will discuss how to recognize and deal with these problems on the day of surgery.
What are The Skin Surgery Center hours of operation?
The Skin and Mohs Surgery Center is open 8:00 a.m. to 5:00 p.m., Monday through Friday. Mohs surgery is scheduled Monday through Friday of each week.
What phone number should I call for scheduling or further details regarding surgery?
During office hours, you may call 336-724-2434. For urgent matters after hours, this number will be directed to the provider on-call. The medical staff of The Skin Surgery Center or Skin Cancer Center is available to assist you on the day of surgery and to answer your questions before and after surgery.
Will my insurance cover the cost of surgery?
Under most circumstances, your carrier will pay for the surgery. If you are a member of an HMO, it may be necessary to obtain a referral or authorization from your primary physician. If you are in doubt about your particular coverage, please check with your insurance representative before your appointment. If you have specific questions regarding insurance or billing matters, please contact our office at 336-724-2434.