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Mohs Surgery

Ninety percent of nonmelanoma cancers are due to sun exposure, which means more people than ever before are developing nonmelanoma skin cancer on body parts that tend to be most exposed to the sun: the face, neck, hands, and feet. Scarring and skin tissue removal are huge concerns to patients who are facing cancer surgery on these areas. Fortunately, Mohs surgery – or simply “Mohs” – offers an alternative to traditional surgery.
 
Featured Story : Tip of the Iceberg

By the time you have made it to your Mohs surgery appointment, typically many prior steps have already happened. Perhaps you first noticed a bump or a spot that bled when you washed your face many months before. You thought it was a pimple or a blemish, but eventually, after several months, you realized this was not your average zit, and it was time to see a doctor. Read more >>

mohs surgery conditionsIn most cases, Mohs Surgery is performed to removed Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC).
 
Basal Cell Carcinoma (BCC), also known as basal cell epithelioma, is the most common form of skin cancer. Basal cell carcinoma usually occurs on sun-damaged skin, especially in light-skinned individuals with a long history of chronic sun exposure. Although it requires treatment to prevent it from becoming too invasive, basal cell carcinoma does not typically metastasize, or spread to lymph nodes or internal organs. Learn more about BCC

Squamous Cell Carcinoma (SCC) is the second most common form of skin cancer. Squamous cell carcinoma usually occurs on sun-damaged skin, especially in light-skinned individuals with a long history of chronic sun exposure.

Squamous cell carcinoma requires treatment to prevent it from becoming too invasive. If it is caught early and treated appropriately, squamous cell carcinoma rarely spreads (metastasizes) to lymph nodes or to internal organs. However, if it is neglected, squamous cell carcinoma can cause tissue destruction or it may spread internally, causing serious health problems and even death. Learn more about SCC

mohs procedure 


Local anesthetic is injected

Affected area is curettaged

Affected area is cut for mapping

Removed area is prepared and labeled

Slides area created

The surgeon checks the slides to determine the next step

The affected area is sutured after all cancer is removed

Mohs Surgery Procedure excerpt taken from: Mohs Surgery : What To Expect by Dr. Jodi Markus

1. A patient will meet me ahead of time or sometimes on the day of the surgery at my practice.

2. Once a patient is in the room where the procedure takes place, I talk with them. I administer a local anesthesia to the area where I plan to remove the tumor.

3. Once the area is ready, I cut a very small piece of tissue. Because of my equipment and training, I’m able to look at 100% of the peripheral and deep margins. This is how a Mohs surgeon refers to the tissue surrounding every side of the tumor. It usually takes around 5 minutes to perform this part of the procedure. It’s a lot like a biopsy.Afterward, we place a small bandage over the wound and ask the patient to wait while we process the tissue.

4. At this point I create a special map of the tissue. This allows me to see exactly where the tumor growth is extending. For example, I’ll say to myself, “I got it all out except at 3:00.” Because I’m the surgeon and I’m the pathologist, I know precisely where the tumor growth is. Then I’ll remove a little bit more tissue in the exact spot where the tumor is extending its growth. If I analyze this and still see microscopic growth, I’ll go a little further. I continue until the tumor is all out. This process is what goes on behind the scenes. Each time I go back to get another piece of tissue, it’s called a stage and the cycle starts all over.

5. Usually the Mohs surgeon will get the entire tumor out on the first removal. Sometimes, however, there are two or three stages for the same surgery. It is very unusual to have more than three stages, but it can happen. Because I’m working with local anesthesia, my patient is completely awake during the process. While I’m analyzing my patient’s tissue, they are in the surgical suite or in the waiting room – either watching television, listening to music, or reading a book.

6. I work with a specially-trained Mohs histotechnician who prepares the slides for analysis. Because the success of a Mohs surgery depends on the quality of the slide, there is absolutely no room for error. The slides must be perfect. The histotechnician uses a special machine to freeze the tissue. When the slide is prepared I read it. By the time all this happens it’s been about 30 minutes. I’ll go back to the patient, numb up the area and remove more tissue at the exact spot where I mapped it. In our example, this would be at the 3:00 position. As I described in my first post, I know exactly where to go to remove more tissue. There is absolutely no risk for miscommunication between the pathologist and surgeon because I am the same person!

7. When the slides indicate a completely clear peripheral and deep margin, I’m done. I’ll numb up the area one last time and repair it. Usually there is only a tiny defect. My patient can then go home. From beginning to end the process takes a couple hours.

Education
• Assistant Professor of Dermatology and Dermatologic Surgery – Baylor College of Medicine and MED VA Medical Center
• Baylor College of Medicine

Fellowships:
• Harvard Department of Dermatology – Biochemical aspects of ultraviolet skin damage
• Baylor College of Medicine – Mohs Surgery and Laser Surgery Procedural Fellowship

Education
• MD University of Washington School of Medicine
• PhD Molecular Biotechnology, Institute for Systems Biology at the University of Washington
• BS Chemical Engineering, Massachusetts Institute of Technology

Post-doctoral training and residency
• Fellowship in Mohs surgery, facial reconstruction, Laser surgery and cosmetic dermatology, University of California, San Francisco
• Dermatology Residency, University of Rochester
• Internship, Internal Medicine, University of Washington