San Jose Office (408) 335-3966
Modesto Office (209) 338-7758
WHAT
IS MOHS SURGERY?
In
the early 1940’s Frederick Mohs, professor of surgery at the University of
Wisconsin, developed a form of treatment for skin cancers he called
chemosurgery. “Chemosurgery” is derived from the words “chemical” and
“surgery”. The addition of “Mohs” honors the doctor who developed the
technique. It is a highly specialized form of treatment for the total removal
of skin cancers. It is performed by a team of medical personnel that includes
physicians, technicians, and nurses or medical assistants. Dr. Mehrany who is
heading the team has had subspecialty (fellowship) surgical training in the
technique and is recognized by the American College of Mohs Micrographic
Surgery and Cutaneous Oncology. A technician, whom you may not even meet,
performs the important task of preparing the tissue slides, which are examined
under a microscope by Dr. Mehrany.
The
word “chemosurgery” when used today is really a misnomer. When Dr. Mohs
initially introduced the procedures, he applied a chemical (zinc chloride) to
the tumor and surrounding skin which fixed the tissue prior to its removal.
Since 1974, the procedure has been refined and improved upon so the vast
majority of cases are done using fresh tissue (omitting the chemical paste).
Although
the official name for the procedure is Mohs micrographic surgery, we prefer the
shortened version of Mohs Surgery. The surgery is performed as follows: the
skin suspicious for cancer is treated with a local anesthetic so there is no
feeling of pain in the area. To remove most of the visible skin cancer, the
tumor is scraped using a sharp instrument called a curette. A thin piece of
tissue is then removed surgically around the scraped skin and carefully divided
into pieces that will fit on a microscope slide; the edges are marked with
colored dyes; a careful map or diagram of the tissue removed is made; and the
tissue is frozen by the technician. Thin slices can then be made from the
frozen tissue and examined by the doctor under the microscope. Most bleeding is
controlled using pressure and other routine measures, although occasionally a
small blood vessel is encountered which must be tied using suture material. A
pressure dressing is then applied and the patient is asked to wait while the
slides are being processed. Dr. Mehrany will then examine the slides under the
microscope and be able to tell if any tumor is still present. If cancer cells
remain, they can be located by referring to the map. Another layer of tissue is
then removed, and the procedure is repeated until Dr. Mehrany is satisfied that
the entire base and sides of the wound have no cancer cells remaining. As well
as ensuring total removal of the cancer, this process preserves as much normal,
healthy surrounding skin as possible.
The
removal and processing of each layer of tissue takes approximately 1-2 hours.
Only 20 to 30 minutes of that is spent in the actual surgical procedure. The
remaining time is required for slide preparation and interpretation.
It
usually takes removal of two or three layers of tissue (called stages) to
complete the surgery. Therefore, by beginning early in the morning, Mohs
Surgery is generally finished in one day. Sometimes, however, a tumor may be
extensive enough to necessitate continuing surgery a second day.
At
the end of Mohs Surgery, you will be left with a surgical wound. This wound will be reconstructed in one of several ways. The several options may be discussed with
you in order to provide the best possible cosmetic outcome.
The
possibilities include:
Healing
by spontaneous granulation involves letting the wound heal by itself. This
offers a good chance to observe the wound as it heals after removal of a
difficult tumor. Experience has taught us that there are certain areas of the
body where nature will heal a wound as nicely as any further surgical
procedure. There are also times when a wound will be left to heal knowing that
if the resultant scar is unacceptable, some form of reconstructive surgery can
be performed at a later date.
Closing
the wound with stitches is often performed on a small lesion. This involves
some adjustment of the wound and sewing the skin edges together. This procedure
speeds healing and can offer a good cosmetic result. For example, the scar can
be hidden in a wrinkle line.
Skin
grafts involve covering a surgery site with skin from another area of the body.
There are two types of skin grafts.
The
first is called a split-thickness graft. This is a thin shave of skin, usually
taken from the thigh, which is used to cover a surgical wound. This can be
either a permanent coverage or temporary coverage before another cosmetic
procedure is done at a later date.
The
second graft type is the full thickness graft. This graft requires a thicker
layer of skin to achieve proper results. In this instance, skin is usually
removed from around the ear or collar bone (the donor site) and stitched to
cover a wound. The donor site is then sutured together to provide a good
cosmetic result.
Skin
flaps involve movement of adjacent, healthy tissue to cover a surgical site.
Where practical, they are chosen because of the excellent cosmetic match of
nearby skin.
If
your Mohs Surgery is extensive or performed where a functional impairment
results, we may recommend you visit one of several consultant physicians. If
you have been sent to us by a physician skilled in skin closures (for example,
a plastic or reconstructive surgeon), he or she may take care of you after your
cancer has been removed.
In summary, by microscopically pinpointing affected skin cancer areas and removing these tissues, Dr. Mehrany can successfully remove your skin cancer. Because normal tissue is preserved to the greatest extent possible, Dr. Mehrany is able to offer you the possibility of an optimal cosmetic result. Although the fullest attempt will be made to minimize the scar, there is always a scar with surgery. There is no such thing as scar-less surgery.
Advantages
of Mohs Surgyery
Mohs
Micrographic Surgery is an advanced treatment procedure for skin cancer, which
offers the highest potential for recovery – even if the skin cancer has
previously been treated. This procedure is a state of the art treatment in
which the physician serves as the Mohs surgeon, pathologist and reconstructive
surgeon.
The
technique allows for the highest possible cure rates while conserving the most
tissue to assure the best possible cosmetic outcome.
This
procedure allows the dermatologists, trained in Mohs Surgery, to see beyond the
visible disease, and to precisely identify and remove the entire tumor, leaving
healthy tissue unharmed. Mohs surgery is most often used in treating two of the
most common forms of skin cancer: basal cell carcinoma and squamous cell
carcinoma.
The
cure rates for Mohs Micrographic Surgery are the highest of all treatments for
skin cancer -- up to 99 percent, even if other forms of treatment have failed.
This
procedure is the most exact and precise method of cancer removal, minimizing
the chances of cancer re-growth and decreasing the potential for scarring or
disfigurement.
COMMON INDICATIONS FOR MOHS SURGERY INCLUDE: