Mohs Surgery (cont.)
Gary W. Cole, MD, FAAD
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is Mohs surgery?
- Why is the procedure called Mohs?
- Where can I have Mohs surgery, and how long does the surgery take?
- What kind of physician can perform Mohs surgery? Where can I find a doctor board-certified in Mohs?
- Is Mohs only for skin cancer?
- Am I a good candidate for Mohs surgery?
- What if I have artificial joints or other health issues?
- What areas are treatable by Mohs surgery?
- What are possible complications of Mohs?
- What is reconstruction? Will I have a scar after Mohs surgery?
- What about insurance coverage and costs of Mohs surgery?
- What are alternatives for Mohs surgery?
- How do I prepare for my Mohs surgery?
- What is the recovery time for Mohs surgery? Is Mohs painful?
- How do I take care of my surgical area after Mohs surgery?
- What is the chance that my cancer will recur after Mohs surgery?
- How many "levels" of Mohs surgery will I need?
- How are skin cancers treated?
- Find a local Dermatologist in your town
What about insurance coverage and costs of Mohs surgery?
Mohs surgery is generally considered a medical service and is not considered cosmetic. Currently, most insurance plans cover the procedure under their provided benefits. However, with the many changes in insurance plans, it is always advisable to contact your insurance carrier prior to scheduling surgery and confirm your eligibility and benefits.
Mohs, like any surgical procedure, will result in additional procedure charges above the routine office-visit fees. These surgical fees may range from $1,000-$3,000 depending on the area, number of levels, and the type of closure or repair required. The greater the number of levels required, the higher the cost. Surgical centers and hospitals usually have a much greater costs associated with a facility fee in addition to the surgery fee.
Insurance benefits vary and reimbursement depends on what benefits you have contracted for with your company. Currently, Medicare generally covers 80% of Mohs cancer surgery. If you have a secondary insurance plan, that may help take care of the remainder 20% not covered by Medicare.
Commercial or non-Medicare insurance generally cover a large percentage of the surgical cost, not including any deductible expense.
What are alternatives for Mohs surgery?
It is important to understand that there are alternative treatments and options to Mohs. Additional treatment choices include (but are not limited to) local radiation, plastic surgery, curettage and desiccation (scrape and burn), regular excisional surgery, cryosurgery (deep freezing), and photodynamic therapy (uses a type of light and a light-activated chemical called a photosensitizer).
How do I prepare for my Mohs surgery?
Your personal physician will give you the preoperative instructions specific for your condition.
Heavy alcohol use is not advised at least one week before surgery. Heavy alcohol use can cause more bleeding and thin your blood. An occasional glass of wine or small cocktail may not cause severe bleeding. Your physician will want to know of any factors that may affect your surgery or wound healing.
Since the duration of the procedure is not known, most patients are advised to eat a good breakfast on the day of surgery and take all of their regular daily medications. Patients are advised to wear comfortable casual clothes and bring a sweater or small blanket. In most cases, patients are able to drive after most procedures and do not necessarily need a driver unless they feel uncomfortable. Diabetic patients may need to be more cautious about maintaining good blood sugars and avoiding dangerous lows in their sugars from fasting. Bring some personal snacks, drinks, and reading or knitting material. Personal music headsets or iPods may also provide relaxation and help pass time.
For surgery center or hospital-based procedures requiring any type of sedation or general anesthesia, patients may be required to not eat or drink anything past midnight the night before surgery. Your surgeon or anesthesiologist will advise you of specific instructions before surgery.
Most patients continue all doctor prescribed medications including aspirin and any blood-thinning medication unless specifically advised otherwise only by the primary physician or plastic or Mohs surgeon. Patients with a significant history of stroke, heart attacks, or even heart pain (angina) under a doctor's care must discuss their medications with their doctor before making any changes. It is important to not discontinue blood thinners without a doctor's specific instructions because of a potential greater risk of a heart attack and/or stroke.
For otherwise healthy (non-cardiac and non-stroke patients) nonessential, nonmedically prescribed medications that thin the blood such as ibuprofen (Advil, Motrin), aspirin, vitamin E, garlic supplements, Alka-Seltzer, Pepto-Bismol, other aspirin-containing medications, etc., can be stopped at least seven to 14 days before undergoing Mohs surgery to minimize bleeding and bruising. These medications can thin your blood and make you more prone to bleed during and after surgery. Again, it is important to not discontinue or start any medication without a doctor's specific instruction.
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