Frequently Asked Questions (FAQ)

What is Skin Cancer?

What is Basal Cell and Squamous Cell Carcinoma?

What About Melanoma?

How Successful is the Treatment of Skin Cancer?

How Do I Prepare for the Day of Surgery?

What Happens the Day of Surgery?

What can I Expect After the Surgery is Complete?

Will I Develop More Skin Cancers?

 WHAT IS SKIN CANCER?

Cancer is the abnormal growth of cells at an uncontrolled and unpredictable rate. The cancer tissue usually grows at the expense of surrounding normal tissue. In the skin, the most common types of cancers are basal cell carcinoma and squamous cell carcinoma. The names reflect the cell within the skin from which the particular type of skin cancer originates. Malignant melanoma or a “cancerous mole” is a rarer type of skin cancer that usually appears as a dark colored spot or bump on your skin and slowly enlarges. In the Mohs Surgery office, we treat basal cell carcinomas, squamous cell carcinomas, malignant melanoma, and some more unusual skin tumors.

 WHAT IS BASAL CELL AND SQUAMOUS CELL CARCINOMA?

Both of these cancers behave and are treated similarly. The difference lies in the cell from which it originates within the skin. Often, this can only be distinguished by examining the skin under a microscope. Basal cell carcinoma is the most common cancer of any type, with about one million new cases a year in the U.S. Both basal and squamous cell carcinoma most commonly occur on the head and neck. The carcinoma often begins as a small bump that can look like a pimple, but will continue to enlarge, often bleeds, and does not heal completely. It may be red, flesh-colored, or darker than the surrounding skin. Basal cell carcinoma rarely spreads (metastasizes) to distant parts of the body. Instead, it grows larger and deeper, destroying nearby parts of the body in its path. Squamous cell carcinoma behaves locally like basal cell carcinoma. However, certain tumors can metastasize from the skin.

The abnormal growth (cancer) originates in the uppermost layer of the skin. The cancer then grows downward, forming root and fingerlike projections under the surface of the skin. Unfortunately, at times these roots are so subtle they cannot be seen without the aid of a microscope. Therefore, what you see on your skin is sometimes only a small portion of the total tumor. There are several different types of basal and squamous cell carcinoma. It is important to distinguish these types prior to treatment, as different therapies may be required. For this reason, a biopsy is usually performed prior to any treatment.

Like other cancers, the cause of skin cancer is unknown. The most common association with skin cancer is long-term exposure to sunlight. This is why skin cancers develop most often on the face and the arms (sun-exposed body parts). They occur more commonly in fair-skinned people than dark-skinned people and in the United States they are found more frequently in the southern (sun-belt) areas. Radiation therapy, trauma (scars), certain chemicals and rare inherited diseases may also contribute to the development of skin cancer.

 WHAT ABOUT MELANOMA?

Melanoma is the deadliest skin cancer accounting for two-thirds of all deaths attributed to skin cancers. The standard treatment for melanoma is local excision of a margin of normal appearing skin surrounding the melanoma. There are, however, special cases, especially on the head and neck region, where Mohs micrographic surgery is beneficial in the treatment of melanoma. Many of the melanomas in this region have poorly defined borders making standard excisions difficult.

Mohs Surgery in the treatment of melanoma is modified. The initial stages done by frozen sectioning is the same as for other skin cancers.

At the conclusion of the standard Mohs Surgery, however, an additional rim of tissue maybe removed for additional histological examination that can take a few days to process. This additional step allows for a more precise treatment of the melanoma.

Accordingly, the reconstruction will be delayed until this final rim of tissue is cancer free.

 HOW SUCCESSFUL IS THE TREATMENT OF SKIN CANCER?

Initial treatment of skin cancers has a success rate greater than 90 percent. Methods commonly employed to treat skin cancer include excision (surgical removal and stitching); curettage and electrodessication (scraping and burning with an electric needle); cryosurgery (freezing); and radiation therapy (“deep x-ray”). The method chosen depends upon several factors, such as the microscopic type of the tumor, the location and size of the cancer and previous therapy. You may have had one or more of these methods of treatment before coming for Mohs Surgery.

If a skin cancer previously treated by one of the above techniques recurs (comes back), retreating using these methods has a success rate of less than 75 percent.

The success rate for Mohs Surgery, even in treating these recurrent lesions, is about 97-98 percent. Mohs Surgery (discussed in detail later) is very time consuming and requires a highly trained team of medical personnel. The vast majority of Mohs surgeons are dermatologists who have had extensive fellowship training after completing their dermatology training. Dr. Mehrany is a fellowship trained Mohs Surgeon and is a member of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Many skin cancers that are easily/effectively treated by the other methods listed previously do not require Mohs Surgery. Mohs Surgery is reserved for recurrent skin cancers or for primary skin cancers which are difficult to treat initially with other therapies.

 HOW DO I PREPARE FOR THE DAY OF SURGERY?

The best preparation of Mohs Surgery is a good night’s rest followed by breakfast. In most cases, the surgery will be completed on an outpatient basis. Because you can expect to be here for most of the day, it is wise to bring along a book or magazine, as well as something to eat for lunch. If you prefer there are a few restuarants that are within 5 minutes from the office. Also, because the day may prove to be quite tiring, it is advisable to have someone accompany you the day of surgery to provide companionship and a ride home.

You may be asked to have a preoperative visit to discuss your surgery. At this visit, the technique will be discussed in detail, a biopsy may be performed (if it has not already been done) and necessary paperwork will be finished (consents, insurance forms, etc.).

If you are coming a great distance and/or are being referred by a physician familiar with the technique, you may be referred directly for Mohs Surgery without a preoperative visit.

We request that you stop taking any aspirin, ibuprofen, or Vitamin E compounds (like Anacin, Bufferin, Advil, Motrin or multi-vitamins) at least one week or preferably two weeks before your surgery. This is because it may interfere with the normal blood clotting mechanism, making you bleed more than normal during surgery. If a physician prescribes your aspirin, please notify your physician before discontinuing the aspirin.

The cost of Mohs Surgery and reconstruction is borne by most insurance carriers as it is medically necessary.

 WHAT HAPPENS THE DAY OF SURGERY?

Your appointment has purposely been scheduled early in the day. Upon your arrival you should check in at the front desk. Once the surgery room becomes available, you will be escorted by our medical assistant to that area of the office. If you have not had a prior consultation visit, Dr. Mehrany will allow time before the surgery to go through the procedure with you and answer any questions that you may have.

After preliminary preparation of the skin, you will be placed on the surgical chair and the area around your skin cancer will be anesthetized (numbed) using a local anesthetic. This may be uncomfortable, but usually this is the only pain you will feel during the procedure. Once the area is numbed, a layer of tissue will be removed and the bleeding controlled. The layer of tissue removed will be carefully handled by the surgeon, diagrammed, and sent to the technician to be processed into microscopic slides. A pressure dressing will be applied over your surgical wound and you will be free to leave the surgical room. On the average, it takes 1-2 hours for the slides to be prepared and studied. During this time you may wait in the front waiting room.

Most Mohs Surgery cases are on average completed in two or three stages. You will be reanesthetized for each stage needed. Each stage involves the removal and microscopic examination of your skin for cancer.

Therefore, the majority of cases are finished during one day. Once we are sure that we have totally removed your skin cancer, we will discuss with you our recommendations for dealing with your surgical wound. Often, the wound can be closed the same day.

 WHAT CAN I EXPECT AFTER THE SURGERY IS COMPLETE?

Pain

Most people are concerned about pain. You will experience remarkably little discomfort after your surgery. Due to its potential to cause bleeding, we request that you do not take aspirin, but use Tylenol or a Tylenol-like pain killer. Rarely will a stronger pain medicine be prescribed.

Bleeding

A small number of patients will experience some post-operative bleeding. It can usually be controlled by the use of pressure. You should take a gauze pad and apply constant pressure over the bleeding point for 15 minutes; do not lift up or relieve the pressure at all during that period of time (no peeking). If bleeding persists after continued pressure for 15 minutes, repeat the pressure for another 15 minutes. If this fails, then apply a third round of 15 minutes of pressure.

Finally, if the bleeding persists then Dr. Mehrany can be reached 24 hours a day by calling his cell phone. If you are unable to directly contact Dr. Mehrany then visit a local emergency room for assistance. Your wound care instructions (given at the end of surgery) will also list his phone number if you have questions.

Complications

There are some minor complications which may occur after Mohs Surgery. A small red area may develop around your wound. This is normal and does not necessarily indicate infection. However, if the redness does not subside in two days or the wound begins to drain pus, you should notify Dr. Mehrany immediately.

Itching and redness around the wound, especially in area where adhesive tape has been applied, are not uncommon. If this occurs, ask you pharmacist for a non-allergenic tape and tell us on your return visit.

Swelling and bruising are very common following Mohs Surgery, particularly when performed around the eyes and mouth. This usually subsides within four to five days after surgery and may be decreased by the use of an ice pack in the first 24 hours.

Numbness

At times, the area surrounding your operative site will be numb to the touch. This area of numbness may persist for several months or longer. In some instances it may be permanent. If this occurs, please discuss it with Dr. Mehrany at your follow-up visit.

Although every effort will be made to offer the best possible cosmetic result, you will be left with a scar. The scar can be minimized by the proper care of your wound.

We will discuss wound care in detail with you and give you a Wound Care Information Sheet, which will explicitly outline how to take care of whatever type of wound you have.

 WILL I DEVELOP MORE SKIN CANCERS?

After having skin cancer, statistics say that you have a higher chance of developing another. The damage your skin has already received from the sun can not be reversed. However, there are precautions that can be taken to prevent further skin cancers. They involve good common sense. You should use a sunscreen applying it at least 10 minutes before exposure to sunlight.

The sunscreens are now labeled as to strength; the higher numbers are more protective. We would recommend that you use a #30 or higher SPF sunscreen. Despite manufacturers’ claims, we recommend that you reapply sunscreen every two hours when in the sun and after swimming. A wide-brimmed hat, long sleeved shirt and other protective clothing are also appropriate. Avoiding excess sunshine is recommended.

You should have your skin checked very closely by your referring physician 2-3 months after our surgery. This is not only to check the surgical site as it is healing, but also to check for the development of additional skin cancers. Our policy is for us to follow the majority of our patients until the wound has healed, and then they can continue to be followed very well by their referring physician.

We recommend 3-6 month follow-up visits for two years, then yearly. Of course, any area of your skin that changes, fails to heal, or just concerns you should be brought to the attention of your referring physician immediately. He or she will be able to adequately determine most skin cancers when they are detected early and are small.