What is Mohs Micrographic Surgery?
Mohs Micrographic Surgery is a highly specialized and exceedingly effective technique for removing many types of skin cancer. The Mohs surgery technique was developed in the 1930s by Dr. Frederic Mohs at the University of Wisconsin. It is now commonly practiced worldwide. Mohs surgery involves a specialized technique for examining removed tissue to identify the specific areas where any roots or extensions of malignant tissue may remain. Because of the methods used, Mohs surgery is recognized as the treatment for skin cancer with the highest success rate.

What are the qualifications of a Mohs surgeon?
Mohs surgery requires a broad set of skills and training of the physician, including dermatological surgery, dermatopathology, dermatology, as well as basic and advanced training in Mohs surgery itself. In addition, the proper surgical and laboratory setting is required as well as a properly trained nursing staff and histotechnological staff. Dermatology and Skin Cancer Surgery Center is proud to possess these facilities and Dr. Matthew D. Barrows, MD is a trained, qualified and highly experienced Mohs surgeon.

What are the advantages of Mohs surgery over traditional treatments?
Because many skin cancers have roots and extensions under the skin that are not readily identifiable from the surface, it is desirable to use a treatment option that allows for the identification and removal of the entire malignancy with the least amount of damage to the surrounding healthy tissue. Mohs surgery was developed as a specific technique for removing these types of skin cancers by tracking and removing the extensions and roots methodically.

When is Mohs surgery indicated?
Mohs surgery is not indicated for all skin cancers. Typically, it is used for cancers that have a high chance of recurrence or have already recurred. Additionally, cancers in high visibility or functional areas such as the nose, ears, eyelids, lips, hairline, hands, feet, and genitals may require Mohs surgery because of the need to preserve the maximum possible amount of healthy tissue.

Is Mohs surgery covered by insurance?
Most insurance policies cover Mohs surgery as well as the reconstruction of the surgical area. Please contact your insurance carrier for specific payment information. You may also contact our office and speak with our billing specialist for assistance in determining your carrier's coverage for this type of surgery.

What should I do to prepare for Mohs surgery?
Continue any prescription medications you are currently taking unless directed otherwise by your physician. If you are taking any blood thinning medications such as coumadin, Plavix, aspirin, aspirin substitutes (Advil, Motrin, Nafton, Naprosyn, etc.), vitamin E, gingko, garlic, ginseng, ginger, ephedra, or other nutritional supplements you should notify your Mohs surgeon. These medications and supplements can cause excessive bleeding after surgery. Prior to surgery, you should get a full night's sleep. You should eat normally the day of your surgery. Wear comfortable clothes to your appointment, and bring something to read and perhaps a snack to pass the waiting time. You may also want to arrange for someone to drive you home after surgery if needed.

What is involved in the Mohs surgery procedure?
Mohs surgery is an outpatient procedure. Dermatology and Skin Cancer Surgery Center has all of the required facilities and personnel to complete the procedure in our office. You will remain awake during the procedure, and you should expect minimal discomfort. The procedure begins with a cleansing and marking of the treatment area and the application of a local anesthetic. The visible cancer is removed along with a thin layer of additional tissue. This takes only a few minutes. The tissue is the processed and examined while the patient waits. After examining the tissue under a microscope, the surgeon determines where any microscopic roots or extensions exist. If residual cancer is found, the precise areas are marked and removed in the same way. This new specimen is then examined to determine if the roots or extensions extend beyond the removed tissue. This process is repeated until all remaining signs of malignancy have been removed.

How long does Mohs surgery take?
Most cases take less than four hours to complete, requiring three or fewer stages of tissue to be removed. It is not possible to predict the extent of a skin cancer's roots or extensions in advance. Therefore, it is advisable to reserve the entire day for this surgery.

How well will the wound heal after Mohs surgery?
A scar will remain after the surgical area has healed completely. However, Mohs surgery leaves the smallest possible scars of any skin cancer treatment.

Are there any potential complications associate with Mohs surgery?
No procedure is free of potential complications. Mohs surgery is not an exception. Tiny nerve endings are cut during surgery. This can produce temporary or permanent numbness around the surgical area. Removal of large skin cancers sometimes require that nerves to muscles are cut. This can result in temporary or permanent weakness in the area. This is quite unusual, however. You can expect the surgical area to remain tender for several weeks following surgery. The length of time will vary depending upon the size of the cancer removed. In rare cases, patients may experience intermittent itching or shooting pain in the surgical area. In addition, some skin flaps and grafts fail to survive fully. This would require a touch up procedure for additional repair.

Please refer to the American Society for Mohs Surgery for more information.