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Mohs surgery and Skin Cancer Q&A with Dr. Jennifer Herrmann

Posted on: April 26th, 2018 by Dr. Jennifer Herrmann

Mohs micrographic surgery is a highly precise method for removing skin cancer. It was named after Dr. Frederic Mohs in the 1930s and has been modernized over time. Mohs Skin Cancer surgery offers three unbeatable benefits: the highest cure rates, significantly minimized scarring, and quicker recovery. Through direct microscopic examination and specialized marking techniques, the board certified and fellowship-trained Mohs surgeons at Moy, Fincher, Chipps Facial Plastics & Dermatology remove only cancerous areas and preserve as much healthy skin as possible. This minimizes scarring and is especially useful when treating skin cancers on the face, neck, ears, and hands. Learn more by reading this Question and Answer Interview with one of Beverly Hills leading skin cancer surgeons, Dr. Jennifer Herrmann.

Q: What is Mohs Surgery?

A: Mohs surgery is a highly specialized technique used to remove skin cancer with the highest cure rates. Using the Mohs technique, we start by removing a very precise layer of skin around the skin cancer. This layer is marked and mapped, and then processed onto microscope slides. The Mohs surgeon then analyzes these slides looking for remaining cancer. Because 100% of the skin edges are checked, we are able to accurately identify any remaining cancer roots. If remaining cancer is seen, using the map to determine where the cancer is oriented on the skin, a second “layer” of skin is removed around the remaining cancer root. This skin piece is similarly processed and analyzed, and these steps are continued until all of the skin cancer is removed. Mohs surgery is essentially a series of expedited skin biopsies where we get final confirmation of the cancer being removed the same day as surgery. Because 100% of the skin edges are examined, we are able to remove cancers with high confidence, giving a 98-99% cure rate. In addition, 100% margin control allows us to keep wounds as small as possible, which is very important on areas such as the face, neck, hands, and feet. Smaller wounds mean less scarring and faster recovery for our patients. If wounds are very small, they are often left to heal by nature and may result in almost no scarring. If wounds are larger, we offer surgical reconstruction the same day as surgery. Dr. Moy, Dr. Fincher, Dr. Chipps, and I are all specifically trained in facial plastic reconstructive surgery techniques and use very precise suturing (stitching) methods to give patients the best cosmetic outcomes possible. Our ultimate goal is to restore your skin to how it looked before the skin cancer grew.

Q: What are the advantages of Mohs Surgery over other skin cancer treatments?

A: There are three main advantages of Mohs surgery. First, because 100% of the tissue edges are checked when we remove skin around the cancer, we are able to very confidently remove all of the cancer on the same day as surgery. Cure rates are between 98 and 99% for most skin cancers treated with Mohs surgery. Second, because we only remove cancerous skin and spare as much normal surrounding skin as possible, we are able to keep surgical wounds as small as possible. This is important for the third main advantage: faster recovery and minimized scarring.

Q: What are the risks of Mohs Surgery?

A: In general, Mohs surgery is very safe. The procedure is performed in the office and patients are awake and alert. Before the cancer is removed, local anesthetic is used to numb the skin, so that patients are comfortable. As with any minor surgery, bleeding and swelling are possible, but these are temporary. To minimize bleeding we recommend that patients stop elective, non-prescription supplements such as baby aspirin, fish oil, vitamin E, and garlic, which are blood thinners. The risk of infection is small with Mohs surgery, and we discuss proper wound care with patients to help minimize this risk. Finally, although scarring is possible because the Mohs technique involves cutting the skin, we do everything possible to minimize this. Using both meticulous surgical technique and certain post-surgery refinements, we can greatly reduce noticeable scarring.

Q: What types of skin cancer can be treated with Mohs Surgery?

A: The most common types of skin cancer treated are basal cell carcinoma and squamous cell carcinoma. But, malignant melanoma, melanoma in situ, merkel cell carcinoma, and rarer cancers of skin glands and hair structures can all be treated with Mohs surgery. Pre-cancers, abnormal moles, and cancers that have spread beyond the skin are best treated with other techniques.

Q: When will Mohs surgery be recommended?

A: Skin cancers may be treated with multiple methods like surgical excision, radiation, electrodessication and curettage (“scrape and burn”) or Mohs surgery. Mohs surgery is usually recommended for skin cancers on areas of critical skin conservation like the face, ears, scalp, neck, hands, ankles, feet, breasts and genitalia. Mohs surgery is also appropriate for skin cancers on other areas of the body that are large, have blurred borders, or appear more aggressive under the microscope. Finally, certain patient characteristics like immunosuppression or specific genetic conditions might guide a surgeon to recommend the Mohs technique over other treatment methods.

Q: How long does it take?

A: Because tissue is processed and examined the same day as Mohs surgery, each “layer” takes approximately 45 minutes to 1 hour to prepare and analyze. If a skin cancer is completely removed in 1 layer and no surgical reconstruction is needed (the wound is left to heal by nature), the entire process may take 1-1.5 hours. If the cancer requires multiple layers and stitching, patients may be in the office for several hours. Surgeries are typically started in the early morning and almost all patients are complete by lunchtime.

Q: Will it hurt?

A: Because the skin is numbed with anesthetic, the procedure itself is painless. We use multiple techniques to minimize discomfort during the numbing process and if the cancer goes beyond one “cut,” we continue to add additional numbing medication before each layer is removed. After the procedure, some discomfort is normal and expected, but typically Extra-Strength Tylenol keeps patients comfortable.

Q: Will I have a scar? What if I have a large tumor?

A: Anytime the skin is cut, there is a chance of scarring. Because the Mohs technique lets us remove as little normal skin as possible minimizing wounds, Mohs surgery typically creates less scarring than other methods of skin cancer removal. To further minimize scarring, we use very precise plastic surgery reconstruction methods when stitching wounds closed, and watch wounds very closely as they heal. If needed, we offer refinement treatments with lasers either at the time of stitching or after the wound heals. The regular use of laser treatment immediately after surgical reconstruction (stitching) helps us produce superior results. In fact, our office has shown and published that lasering over scars immediately after stitching reduces scarring. Although our primary goal is always to completely remove our patients’ cancers, a very close secondary goal is to maximize their cosmetic outcome and minimize scarring.

Q: Will my insurance cover Mohs Surgery?

A: Most insurance companies cover Mohs surgery and surgical reconstruction, if needed. Because every insurance plan in unique and patients’ deductables vary greatly, we recommend that you check with your insurance company to best understand your benefits.

The esteemed skin cancer surgeons at Moy, Fincher, Chipps Facial Plastics & Dermatology offer the highest level of personalized care designed to keep your skin healthy and cancer-free. When you face a skin cancer diagnosis, our Fellowship Trained Mohs Surgeons will listen to your concerns and engage their expertise to provide you with the most advanced treatment for your diagnosis. Schedule a Skin Cancer Screening or Consultation.

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