Mohs Surgery

Mohs Surgery

Mohs Micrographic Surgery is an advanced surgical technique that offers
the highest cure rate – 99% for most types of skin cancer.

Mohs Micrographic Surgery is an advanced surgical technique that offers the highest cure rate - 99% for most types of skin cancer. Furthermore, it is a tissue sparing procedure that offers superior cosmetic results.

With the Mohs technique, surgically removed tissue is carefully mapped, color-coded, and thoroughly examined microscopically by the surgeon on the same day of surgery.

What is important to know about Mohs Micrographic Surgery?

Mohs Micrographic Surgery is an advanced surgical technique that offers the highest cure rate – 99% for most types of skin cancer. Furthermore, it is a tissue sparing procedure that offers superior cosmetic results.  It should be performed by a highly trained and experienced surgeons. Dr. Sidney Smith offers the Mohs procedure at the Georgia Skin and Cancer Clinic Savannah office location. You should understand that

-Not all cancer cells are apparent to the naked eye.

-Many ‘invisible’ cells may form roots or fingers of diseased tissue that can extend beyond the boundaries of a visible cancer.

-If all the cancer cells are not completely removed, the cancer will re-grow, making it necessary to have it removed again.

 

The types of cancer most likely to warrant Mohs Micrographic Surgery

-Are located in cosmetically sensitive or functionally critical areas around the eyes, nose, lips, scalp, fingers, toes or genitals.

-Are large, aggressive, or growing rapidly.

-Are recurrent.

-Have ill-defined edges.

-Non-melanoma skin cancer

Why should I consider Mohs Micrographic Surgery?
For these cancers, common treatment methods may not be successful because they rely on the human eye to determine the extent of the cancer.  These methods may remove too little cancer which can cause it to recur, spread, and require additional surgery.  It can also result in the removal of too much healthy tissue and may cause unnecessary scarring. American College of Mohs Surgeons are fellowship-trained surgeons who have extensive training in skin cancer removal and reconstructive surgery.  Dr. Sidney Smith, who is a member of the American College of Mohs Surgery, is able to perform the  surgery and microscopic analysis in the same day to confirm that the cancer is completely removed .
What to consider with Mohs Micrographic Surgery.
Mohs Micrograhic Surgery is usually performed on an outpatient basis, in one day, under local anesthesia.  The healing process is similar to that of most surgical procedures with minimal discomfort and the greatest preservation of normal tissue, thereby minimizing scarring. It is important to understand that although Mohs surgery can take longer than other techniques to perform, advances in technology, such as automated staining of tissue samples, have made it quicker.While it is impossible to predict exactly what time frame to expect for each Mohs surgery procedure, the entire procedure usually lasts several hours. Patients are advised to plan on the better part of the day if not the full day for tissue processing and clearing the tumor through layers of removal. Dr. Sidney Smith will discuss your post surgery plan for wound healing that may include simple wound healing or plastic surgery reconstruction on the same day or days to follow depending on the wound.
Is skin cancer treatment necessary?
If left untreated, skin cancer can continue to progress and be potentially life-threatening.  Do not delay in getting treatment if you have been diagnosed with skin cancer or have concerns about a skin growth.  Please visit www.mohscollege.org for more information regarding Mohs surgical therapy for your skin cancer.
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About 96 percent of the 1.3 million new cases of skin cancer diagnosed each year in the US is basal cell or squamous cell carcinoma.

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Mohs Micrographic Surgery is the "gold standard" treatment with a 99 percent cure rate.

STEP-BY-STEP

 WHAT YOU CAN EXPECT ON THE DAY OF YOUR MOHS SURGERY

Step 1
Step 1:

Anesthesia: The tumor site is locally infused with anesthesia to completely numb the tissue. General anesthesia is not required for Mohs micrographic surgery.

Step 2
Step 2:

Stage I – Removal of visible tumor Once the skin has been completely numbed, the tumor is gently scraped with a curette, a semi-sharp, scoop-shaped instrument. This helps define the clinical margin between tumor cells and healthy tissue. The first thin, saucer shaped “layer” of tissue is then surgically removed by the Mohs surgeon. An electric needle may be used to stop the bleeding.

 

Step 3
  Step 3:

Mapping the tumor Once a “layer” of tissue has been removed, a “map” or drawing of the tissue and its orientation to local landmarks (e.g. nose, cheek, etc) is made to serve as a guide to the precise location of the tumor. The tissue is labeled and color-coded to correlate with its position on the map. The tissue sections are processed and then examined by the surgeon to thoroughly evaluate for evidence of remaining cancer cells. It takes approximately 2 or more hours to process, stain and examine a tissue section. During this processing period, your wound will be bandaged and you may leave the operative suite.

 

Step 4
Step 4:

Additional stages – Ensuring all cancer cells are removed If any section of the tissue demonstrates cancer cells at the margin, the surgeon returns to that specific area of the tumor, as indicated by the map, and removes another thin layer of tissue only from the precise area where cancer cells were detected. The newly excised tissue is again mapped, color-coded, processed and examined for additional cancer cells. If microscopic analysis still shows evidence of disease, the process continues layer-by layer until the cancer is completely removed. This selective removal of tumor allows for preservation of much of the surrounding normal tissue. Because this systematic microscopic search reveals the roots of the skin cancer, Mohs surgery offers the highest chance for complete removal of the cancer while sparing the normal tissue. Cure rates typically exceed 99% for new cancers, and 95% for recurrent cancers.

 

Step 5
 Step 5:

Reconstruction Fellowship-trained Mohs surgeons are experts in the reconstruction of skin defects. Reconstruction is individualized to preserve normal function and maximize aesthetic outcome. The best method of repairing the wound following surgery is determined only after the cancer is completely removed, as the final defect cannot be predicted prior to surgery. You may be referred to a plastic surgeon on the same or next day.Stitches may be used to close the wound side-to-side, or a skin graft or a flap may be designed. Sometimes, a wound may be allowed to heal naturally.

 

Patient Educational Mohs Video

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What our patients say

Excellent! Dr. Smith and staff were attentive, friendly, and professional. They listened to my concerns and addressed them thoroughly with an assessment followed by a detailed conversation with me about treatments and outcomes Mandy Jones

- May 10, 2017

Very satisfied. Excellent service and very professional. Expertise is beyond comparison. Tom Brewer

- June 3, 2018

Georgia Skin & Cancer Clinic is staffed with professional providers, who care about their patients and their needs – highly recommended! Rick Bean

- January 21, 2019