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.
- What is Mohs surgery?
- Why is the procedure called Mohs?
- Where can I have Mohs surgery? How long does Mohs 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 is Mohs surgery?
Mohs surgery, also referred to as Mohs micrographic surgery (MMS), is a special technique that utilizes both pathology and surgery to remove skin cancers in a physician's office. Tissue containing the tumor is frozen on a cryostat, and very thin horizontal slices of tissue are cut from the bottom-most layers of the skin tumor, positioned on a glass slide, and stained by a technician. The physician then examines these slices under a microscope. A doctor removes and examines repeated saucer-shaped layers of tissue until no more skin cancer is visible.
The procedure includes special dyes that allow the surgeon to remove the entire malignancy using a tumor map showing the sites of any residual cancer cells. During MMS there is an examination of the entire tumor's margins simultaneously while the patient is waiting. If more cancer cells are seen under the microscope, tissue is removed at those sites of involvement. Each skin layer that is removed is called a "level." If no more cancer cells are seen at a particular level, then it is deemed "clear" (no more tumor) and no additional levels are removed.
By removing only tissue where cancer is known to be present, the technique combines a very high cure rate with excellent preservation of normal skin. Once the cancer has been fully removed, the surgeon will determine the type of repair for the best cosmetic result. The surgeon may refer patients to another physician for wound closure, may close the wound immediately, or may let the wound heal on its own.
MMS is special because the entire edge and under-surface of each skin cancer layer is microscopically examined for the presence of cancer cells. Traditional surgical pathology techniques uses vertical sections (bread loafing) and is only helpful to evaluate 1%-3% of the tumor margins, thereby increasing the chances that a small tumor cluster maybe missed and left behind. MMS enables the examination of 100% of the entire tumor's margin, thereby reducing the chance of recurrence of the skin cancer.
MMS surgery is significantly more labor intensive than conventional methods of treating skin cancers, and as a result, it is more expensive. This type of surgery is typically reserved only for certain situations, which include recurrent cancers that have not been cured by conventional techniques, large tumors with indistinct margins, tumors that occur in cosmetically sensitive areas like the mid-facial tissues, and scarring basal cell cancers, which are known to have a high recurrence rate.
MMS is scheduled with the understanding that the patient may be spending the entire day in the office depending on the number of levels necessary to clear the tumor. Most of these procedures are performed with the patient in the waiting room awaiting the verdict from the Mohs surgeon.
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