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Frequently Asked Questions - Mohs Surgery

Providing Exceptional Skin Care & Treatment

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Frequently Asked Questions - Mohs Surgery

Providing Exceptional Skin Care & Treatment

MOHS SURGERY

The Most Effective Treatment for Skin Cancer

Mohs micrographic surgery is the most effective and advanced treatment for skin cancer. It is performed on an outpatient basis using a highly specialized and precise technique that removes the cancer in stages, one tissue layer at a time. This technique allows physicians to precisely identify and remove a tumor while leaving the surrounding healthy tissue intact and unharmed. Mohs surgery offers the highest potential for a cure – even if the skin cancer has been previously treated by another method.

QUESTIONS

MOHS SURGERY FAQ

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.

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.

Skin cancer is a term for a variety of growths on the skin. Other terms are skin tumor and skin malignancy.

  • 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.

Yes. The three most common types of skin cancer include:

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.

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.

Yes. 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.

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.

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.

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.

The Mohs surgeon uses conventional surgical instruments and removes malignant tissue during 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.

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

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.

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.

No. The surgery is well tolerated with local anesthesia. Because the surgery may be time-consuming, the risk of prolonged general anesthesia is avoided.

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.

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.

Due to COVID restrictions, we are not allowing any visitors in the waiting room unless they are needed to directly assist the patient during surgery.  Anyone who comes with the patient will be asked to wait in their car or return at a later time once the patient’s surgery is complete.

It is strongly recommended that you arrange to have someone drive you to and from your appointment.. 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.

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.

Yes. Breakfast is recommended.

Yes. Take your regular medications as they have been prescribed.

Possible hindrances depending on your specific situation will be discussed with you on the day of your 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.

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.

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.

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.

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Have questions or concerns? Please call us at 336.724.2434.

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