Mohs surgery is a highly specialized treatment for the total removal of skin cancer.  This method differs from all other methods of treating skin cancer by the use of Complete Microscopic Examination of all the tissues removed surgically, as well as detailed mapping techniques to allow the surgeon to remove all the roots and extensions of the skin cancer. The procedure begins after the skin is injected with a local anesthetic to make it completely numb.

Then, the visible cancer and a very thin layer of surrounding skin are removed with a scalpel, carefully mapped, and examined microscopically. If there is still cancer seen under the microscope, another very thin layer of skin is removed from the exact location.This may be repeated as often as necessary to completely remove the skin cancer.

By using these detailed mapping techniques and evaluating the complete margins of the specimen, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed.
The result is:

1. The removal of as little normal skin as possible, minimizing the scarring, and 
2. The highest possibility for curing the cancer.

Using Mohs surgery, the cure rate for most primary skin cancers is 98-99%, as opposed to a percentage of cure in the low 90s for regular excision. For most recurrent skin cancers, Mohs surgery still gives a cure rate of more than 90%. Whereas, other methods of treatment offer only a 50-80% chance of success if previous treatments have failed.

Your appointment will be scheduled early in the morning or afternoon. The doctor will numb the area around the skin cancer. The surgical removal of the first tissue layer alone takes only 5-10 minutes. However, it takes a minimum of 30 minutes to prepare the slide and microscopically examine the tissue. Several surgical stages (layers) and microscopic examinations may be required to completely remove the tumor. You will be asked to wait between the stages. Although there is no way to tell before surgery how many stages will be necessary, most cancers are removed in 3 stages or less. Most routine cases are concluded in 3-4 hours. We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material to occupy your time while waiting for the microscopic slides to be processed and examined. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you make no other commitments for the entiremorning or the afternoon that you are scheduled for surgery.

Yes.  Any form of treatment will leave a scar.  However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized, compared to other forms of treatment.  Immediately after the cancer is removed, we may choose to:

1. leave the wound to heal by itself,
2. repair the wound side to side with stitches, or
3. reconstruct the wound with a skin flap or graft.  This decision is based on the safest method that will provide the best cosmetic result.

Most insurance policies cover the cost of Mohs surgery.

Continue any medications prescribed by your doctor. However, aspirin is a drug that prolongs bleeding. We ask that you avoid aspirin or aspirin-containing products (e.g., Anacin, Bufferin, Motrin, Advil, and Naprosyn) for at least one week prior to surgery; unless, your primary physician states otherwise.  If you are taking blood thinners like Coumadin, please let us know before you schedule your surgery. Vitamin E supplements should also be avoided for one week prior to surgery.  Alcohol will also promote bleeding and should be avoided for 24-48 hours before and after surgery. Finally, certain herbal products like gingko can thin the blood.  Any unessential herbal products should be stopped for one week prior to surgery.