Mohs Surgery & Surgical Procedures

Mohs Surgery for Skin Cancer 

Mohs surgery involves removing the visible skin cancer and layers of adjacent skin and   soft tissue to facilitate microscopic examination of the excised tissue. Meticulous maps are created to follow tumor extensions, and excisions are sequentially continued until no cancer cells are evident upon microscopic examination. The surgical wound is then repaired to preserve as much form and function as possible. Mohs micrographic surgery – developed in the 1930s by Dr. Frederic Mohs – offers the highest cure rates in the treatment of basal cell and squamous cell cancers of the skin. Below is an example of before and after photos of one of our Mohs Surgery patients:

Why choose Mohs surgery for skin cancer

Mohs surgery is the most effective treatment for basal cell and squamous cell carcinomas, and it also works much better than conventional treatments for a number of less common skin cancers, including melanoma. Cure rates for many types of skin cancers are 98-99 percent using Mohs surgery – significantly higher than with other treatment methods. Since tissue is removed only until the cancer is no longer present, the Mohs surgical procedure minimizes the size of the surgical wound required for skin cancer treatment and reduces the size and appearance of the resulting surgical scar.

What you should know about Mohs surgery for skin cancer

Mohs surgery often is used in the treatment of skin cancers on the face, scalp, hands, feet and genitals, though it also can be used on other areas of the body. The procedure typically is performed under local anesthesia in the doctor’s office. 

Mohs surgery uses a precise technique to sequentially remove layers of skin and adjacent soft tissue. The excised layers of tissue are frozen, stained with special dyes and then examined under the microscope to determine if they contain remaining cancer cells. If more cancer cells are present, an additional skin layer is then removed and examined. Repeated removals of skin are limited to areas in which cancer cells remain. This sequential excision procedure continues until microscopic examinations confirm that the skin cancer has been completely removed.

After the skin cancer has been removed, the surgeon treats the wound in a manner that will promote both good healing and preservation of appearance. Wound treatment methods include:

Allowing the wound to heal naturally.
Closing the wound simply with stitches.
Cover the wound with skin from another area of the body (skin graft) or from an adjacent area (skin flap).

Possible risks

While Mohs surgery is typically a very safe and effective minor surgical method, all medical procedures carry some risk, though they are minimized in the hands of our Board Certified Dermatologists. Risks include:

  • Bleeding
  • Scarring
  • Discoloration
  • Nerve damage
  • Pain
  • Cancer recurrence
  • The need for additional reconstructive surgery

Estimated cost

The average cost for Mohs surgery is between $1,000 to $2,000 depending on the size of the tumor, the number of tissue layers required to be removed for tumor treatment and subsequent wound management. Mohs surgery is considered a medically necessary procedure and typically is covered by most medical insurance plans.

How to prepare for the procedure

Before the procedure, our Board Certified Dermatologist will review your medical history and discuss expectations, potential risks/benefits and outcomes of the procedure. Please alert your doctor regarding your use of prescription and over-the-counter medicines and supplements.

What to expect after the procedure

Most patients are able to drive themselves home following the procedure. Pain associated with the procedure typically is minimal and temporary. Your doctor may advise you to take an over-the-counter pain reliever or a prescription pain-reducing medication if necessary. Limitations on physical activity depend largely on the extent of the surgical procedure. Patients whose wounds were repaired with stitches will typically need to return to the doctor's office within one to three weeks for their removal. 

What is dermatologic surgery?

Dermatologic surgery is the practice of dermatology that specializes in surgical procedures and minimally invasive treatments to improve the health, function and appearance of your skin.

Who is a dermatologic surgeon?

Our Board Certified Dermatologists are dermatologic surgeons who specializes in skin surgery. Our primary focus is on the health and beauty of your skin – from head to toe. Nearly all dermatologic surgeons perform both medically necessary and cosmetic surgery procedures to maintain the health, function and appearance of your skin.

Dermatologic surgeons are pioneers in the research and development of many of today’s most effective therapeutic and cosmetic skin care solutions. For example, the art and science of procedures for the treatment of skin cancer, aging and sun-damaged skin, unwanted hair, varicose veins, scars, undesirable body fat, hair loss and more were investigated and refined by dermatologic surgeons.

What can our dermatologic surgeons do for you?

Dermatologic surgeons specialize in the use of surgical and non-surgical skills and methods for diagnosing and treating various skin, hair, nail and vein conditions, including benign growths, skin cancers, aging skin, unwanted fat, excess hair and varicose veins. As experts on living skin cells, dermatologic surgeons are uniquely qualified to employ a range of corrective and preventive techniques to keep skin healthy, vibrant and youthful-looking. In fact, dermatologic surgeons are responsible for the development and refinement of many of today’s therapeutic and cosmetic surgery procedures.

Great strides in minimally invasive techniques and today’s advanced technologies now enable dermatologic surgeons to achieve medically effective and cosmetically elegant results. Procedures are typically less intense, safe and heal more quickly than ever before. Further, treatment is usually performed in the physician’s office, which translates to added convenience and cost-effectiveness.

What are the common treatments used in dermatologic surgery?

Anti-aging and cosmetic approaches.

Skin rejuvenation techniques include topical products applied to the skin, botulinum toxin, brow lifts, chemical peels, dermabrasion, eyelid surgeries, laser treatment, liposuction, microdermabrasion, mini face lifts, neck and jowl treatments, and soft-tissue fillers.

Age spots and birthmark correction

With laser and light-based technologies and chemical peels, dermatologic surgeons have dramatically advanced the treatment of birthmarks and age spots, medically referred to as benign vascular and pigmented lesions. They can now successfully treat birthmarks of virtually every size, type and color on all parts of the body with or without scalpels in an out-patient setting.

Chemical peels

Chemical peels are beneficial in the treatment of wrinkles around the eye and mouth, skin discoloration and age spots as well as dull skin texture and mild acne scars. The procedure involves the application of a special chemical solution to remove outer layers of aged, discolored and irregular skin. Fresh skin is then generated, which is usually smoother, less wrinkled and more even in color. Dermatologic surgeons pioneered chemical peeling procedures more than 50 years ago and have perfected a range of peeling techniques and solutions.

Dermabrasion

Dermabrasion is a resurfacing procedure where the skin is mechanically smoothed to achieve a rejuvenated appearance. It is used to treat scarring, remove tattoos and minimize age spots, wrinkles and certain types of skin growths.

Hair loss and restoration

Dermatology is the only medical specialty that focuses on the biology of hair, studying the causes and treatment of hair loss. Having invented hair transplant procedures back in the 1950s, dermatologic surgeons are trained in a combination of techniques to produce the best results. These include hair restoration treatment using standard, mini and micro-grafts; scalp reduction for extensive balding; scalp extenders or tissue expanders; scalp lift and scalp flaps.

Laser hair removal

Laser and light-based technologies have revolutionized the therapeutic and cosmetic practice of dermatologic surgery. By penetrating the melanin in the hair shaft and disabling the hair follicle, long wavelength lasers and pulsed light sources can effectively remove unwanted hair from the face, underarms, back, legs and bikini area on patients of just about all skin types. Laser hair removal also can successfully treat inflamed and bumpy skin caused by ingrown hair.

Laser resurfacing and skin rejuvenation

Laser resurfacing is a cosmetic solution for skin with significant sun damage, wrinkles, acne scars, freckles and age spots. This technique removes the top layers of skin as it gently smoothes and precisely contours the skin surface. Non-ablative (non-wounding) skin rejuvenation is an ideal treatment for those with mild to moderate aging and sun-damaged skin. Non-ablative lasers and light-based devices bypass the top skin layers to stimulate collagen production and tighten underlying skin without patient downtime.

Neuromodulators (botulinum toxin)

First introduced in the U.S. by a dermatologic surgeon in 1991, botulinum toxin injections are used primarily to paralyze certain facial muscles which cause frown lines, crow's feet and other wrinkles. It works by relaxing the underlying facial muscles and that help form wrinkles, an effect that lasts for three to four months. It also is used to improve neck lines and control excessive sweating.

Scar improvement

Whether as the result of acne, a skin disease like chicken pox, stretch marks or trauma to the skin, there are several therapeutic and cosmetic dermatologic remedies to improve the appearance of scars. High-tech lasers, dermabrasion, punch grafts and chemical peelsare some of the more common treatments developed or refined by dermatologic surgeons for scar improvement.

Skin cancer

Dermatologic surgeons are the unrivaled specialists in the diagnosis, removal, closure and overall treatment of skin cancer. From Mohs micrographic surgery to simple biopsy and excisions as well as preventive laser therapy of pre-cancerous growths, dermatologic surgeons can control and effectively treat skin cancer with early detection.

Skin disease management: Acne, psoriasis, rosacea and vitiligo

Advances in laser technology spearheaded by dermatologic surgeons provide new treatments for chronic skin conditions like acne, psoriasis, rosacea and vitiligo. These and other skin disorders, which a mere 10 years ago required extensive and invasive surgery or were simply resistant to treatment, can now be successfully managed.

Soft-tissue augmentation (fillers)

Dermatologic surgeons have developed and tested various natural and synthetic substances to give skin a smoother and more pleasing appearance. Collagen is one of several widely available injectable wrinkle fillers used to “erase” lines, fill and plump furrows and hollows in the face, and enhance the definition of the lips. Certain scars and skin depressions also respond well to soft tissue fillers.

Tattoo removal

Depending on the size and color of your tattoo, the number of treatments will vary. Your tattoo may be removed in two to four visits, though it may take as many as 10 more sessions. You should schedule a consultation, during which time a trained professional will evaluate your personal situation and advise you on the process.