Skin cancer is the uncontrolled growth of abnormal skin cells. It occurs when unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sun or tanning beds) trigger mutations (genetic defects) that lead the skin cells to multiply rapidly and form malignant tumors. Cancerous tumors may spread, invading and damaging nearby tissue. In some cases, skin cancers can spread to vital organs, becoming deadly.
FACTS ABOUT SKIN CANCER
Skin cancer is the most common form of cancer in the United States. Each year over 3.5 million skin cancers are diagnosed in over 2 million people. One in five Americans will develop skin cancer in the course of their lifetime. The two most common forms of skin cancer are Basal cell carcinoma and Squamous cell carcinoma.
Basal cell carcinoma (also know as BCC) can look like a sore that doesn’t completely heal, a shiny bump, or a reddish, irritated portion of the skin in an area that is exposed to the sun, such as the head, ears, face, shoulders and chest. Basal cell carcinomas almost never spread (metastasize) to other parts of the body. They can, however, cause damage by growing and invading surrounding tissue. Squamous cell carcinoma is potentially more aggressive than Basal cell carcinoma. Squamous cell carcinomas (also known as SCC) often develop on sun-exposed areas; however, they can develop on other areas of the body like the mucous membranes and genitals. Mohs surgery is the most effective treatment for these types of skin cancers.
MOHS MICROGRAPHIC SURGERY FAQS
Mohs micrographic surgery is a technique used for skin cancer removal. This surgery can offer cure rates of up to 99% while removing minimal normal tissue resulting in the smallest possible defect. At Feinstein Dermatology & Cosmetic Surgery, we have a full on-site CLIA certified laboratory to insure the most accurate removal of skin cancer. Dr. Feinstein is a Fellow of the American Society for Mohs Surgery and personally performs all Mohs procedures in the comforts of our office.
Q: You have been diagnosed with skin cancer. What is the next step?
A: Your biopsy results reveal a diagnosed form of skin cancer. Dr. Feinstein or one of his trained assistants will discuss with you the various treatment options to remove the skin cancer. In certain circumstances, Dr. Feinstein may recommend Mohs micrographically controlled surgery.
Q: What is Mohs surgery and how is it performed?
A: The term Mohs refers to Dr. Frederic Mohs, Professor of Surgery at the University of Wisconsin, who developed this surgical technique in the 1930s. The technique has undergone many refinements and has come to be known as Mohs micrographic surgery or simply Mohs surgery in honor of Dr. Mohs. With the Mohs technique, Dr. Feinstein or one of his associates, can precisely identify and remove an entire tumor while leave in the surrounding healthy tissue intact and unharmed. This technique involves removing the skin cancer in stages, one tissue layer at a time. It is performed under local anesthesia and in the comfort of our office.
Once a tissue layer is removed, its edges are marked with colored dyes, and a map of the specimen is created. The tissue is then processed onto microscope slides by a Mohs histotechnician. These slides are carefully examined under the microscope by your Mohs surgeon so that any microscopic roots of the cancer can be precisely identified and mapped. If cancer cells are seen, an additional tissue layer is removed only in areas where the cancer is till present, leaving normal skin intact. This saves as much normal, healthy skin as possible. Once the cancer has been removed, Dr. Feinstein or one of his associates will explain options for repair of the wound.
Q: What are the advantages of having Mohs surgery?
A: The advantage of this technique is that a minimum amount of tissue is removed and all the edges of the specimen are carefully studied. This method has the highest success rate of all treatments for skin cancer – up to 99%. Advantages of Mohs surgery include ensuring complete cancer removal during surgery, virtually eliminating the chance of the cancer growing back, minimizing the amount of health tissue lost, maximizing the functional and cosmetic outcome resulting from surgery, repairing the site of the cancer the same day the cancer is removed and curing skin cancer when other methods have failed.
Q: Will my insurance cover the Mohs surgery?
A: Most health insurance policies cover the costs of Mohs surgery and the associated repair. You will be responsible for any deductible, copay or coinsurance not covered by your personal health plan. When assessing the cost-effectiveness of Mohs surgery there are several factors to consider. Because of the number of personnel involved as well as the advanced technology required, the initial procedure is often more costly than other treatment methods. However, because of the procedure’s high success rate, most patients require only a single surgery. While other methods might initially be less expensive than Mohs surgery, additional surgeries may be required to treat the cancer if it is not completely removed. Each of these additional surgeries will require separate fees, while a single Mohs surgery procedure includes all of these into one fee. If you have any additional questions regarding coasts, please contact our billing office.
Q: How should I prepare for Mohs surgery?
A: Unless otherwise directed by Dr. Feinstein or one of his assistants, continue taking your current medication regimen even on the day of the procedure. We recommend wearing comfortable clothing and bring a light jacket as temperatures in the office are kept cold on that day. It is important that the clothing worn be easily accessible to the surgical area. For example, if the surgical area is located on the lower leg, please wear shorts. Either breakfast or lunch along with refreshments (depending on the time of the procedure) will be provided to you. You may wish to bring a book or magazine to occupy your waiting time. The procedure may last anywhere from two to five hours. Also, you may wish to arrange for someone to drive you home following the procedure.
Q: What happens of the day of the surgery?
A: Upon arrival, you will be asked to sign in as well as sign the Mohs consent. One of our front office staff will take your photograph so that this can be attached to your chart for the day. One of our medical assistants will then escort you to the exam room where you will be asked pre-operative questions. The medical assistant will photograph the surgical area and then locally anesthetize.
Dr. Feinstein or one of his associates will then remove a layer of skin involving the skin cancer. After the tissue has been removed, the medical assistant will bandage the surgical area and you will be escorted to the lobby area while the tissue is being prepared for microscopic examination. If the examination of the slide reveals that your tissue still contains cells of skin cancer, the procedure will be repeated until all skin cancer cells have been removed. Following the removal of the skin cancer cells, the most appropriate type of closure will be discussed with the cosmetic, functional and aesthetic considerations in mind.
Q: How do I care for the surgical area following Mohs?
A: Following the procedure, one of the medical assistants will bandage the surgical area and will review in detail all post-operative care instructions for your specific surgical area. Written instructions will also be given at that time. If you have any post-operative concerns, please contact the office at (561) 498-4407.
Q: Will I experience pain after surgery?
A: Most patients experience little to no pain after Mohs surgery. Should you experience pain, take Tylenol only (dosing as directed on the bottle), not aspirin or aspirin-related products such as Motrin, Advil, Aleve, or ibuprofen. If you are taking a baby aspirin daily for therapeutic reasons, you may continue to take it as prescribed. If you are not able to take Tylenol, contact our office for a substitute pain medication.
Q: Will Mohs surgery leave a scar?
A: Yes. As will any treatment for skin cancer, Mohs surgery will leave a scar. However, Mohs surgery preserves as much healthy skin as possible and maximizes options for repairing the defect. Generally, a post-surgical scar improves with time and can take up to one (1) year to fully mature. As your surgical site heals, new blood vessels can appear and support the healing changes occurring underneath the skin. This can result in the reddish appearance of the scar. This change is temporary and will improve with time. If there are problems with the healing of your scar, injections, laser or other treatments may be used to optimize the cosmetic result. Our caring staff will be available for you throughout the healing process to discuss any concerns that may arise.
Q: Are there any complications associated with Mohs Surgery?
A: As with any surgery or procedure, Mohs is associated with possible risks and complications. While it is overall a very safe and effective surgical treatment for skin cancer, there are some possible complications. Possible risks and complications of Mohs include (but are not limited to) bleeding, bruising, wound infection, pain, scarring, keloid formation, cosmetic disfigurement, skin discoloration, nerve damage, wound opening (dehiscence) and splitting of stitches, cancer recurrence and/or need for further surgery or treatment. Overall, most patients tolerate the Mohs surgery well without any complications.
Request your Mohs consultation with Dr. Feinstein
Call us at 1.888.357.DERM to schedule an appointment or