What is Mohs Surgery?
Named after Frederic Mohs, the surgeon who developed the technique in the late 1930's, Mohs surgery is an outpatient form of excisional surgery which can effectively remove most skin cancers one layer at a time. After each layer is removed, it is examined under a microscope to determine whether residual cancer remains in the patient's skin and, if present, determine the location. The result is: 1) the removal of as little normal tissue as possible, and 2) the highest possibility for curing the cancer.
The Benefits of Mohs Surgery
- It is a highly effective means of treating common skin cancers with a success rate for the treatment of primary (never treated) basal cell carcinomas approaching 98 to 99%.
- When used to treat basal cell carcinomas which have come back (recurrent), the success rate is about 95%.
- It is best used to treat skin cancers occurring in and around the face because cancers in this location can dive deep beneath the skin's surface. Mohs surgery aims to remove these invisible "roots" which can produce recurrences if not eradicated. The use of a microscope allows the surgeon to be precise, thereby preserving as much normal tissue as possible while optimizing the chance for cure.
- The patient does not have to be put to sleep and the procedure can be performed in a doctor's office.
How Do You Prepare for Mohs Surgery?
Dr. Paula Lapinski discusses the surgery and answers your questions during a preoperative consultation. A biopsy is performed at this time, if necessary.
Our team needs to know specific information regarding your current medical care:
Medical devices: Please let us know before the day of your Mohs surgery if you have any of the following devices:
- Artificial joints
Medications: Please continue to take blood thinning medications. Dr. Lapinski will provide more information during your consultation. Also, if you have been told to take antibiotics prior to dental or medical procedures in the past, please advise us prior to the day of your surgery.
It's also important to get a good night's sleep followed by a good breakfast, unless you are specifically told not to eat or drink after midnight the night before surgery.
Prepare to spend the entire day with us. Bring reading material, a laptop, needlework or a companion to talk to. The day can be quite tiring. Some patients prefer to have someone drive them home. Discuss this with your physician if you have concerns.
Most insurance carriers cover the cost of Mohs surgery and repair surgery. You can facilitate the process by providing your insurance information to our office.
How is Mohs Surgery Performed?
After the area is numbed with local anesthetic, the visible portion of the cancerous lesion is carefully scraped or removed so that the margins of the lesion are well defined. A 1 to 3 mm margin of tissue is marked beyond the scraped area and the lesion is removed along with the margin, which surrounds the lesion on the sides and underneath. Bleeding is controlled and a pressure dressing is applied to the wound and the patient is asked to return to the waiting room while the tissue is processed.
The tissue is carefully divided into pieces and the edges marked and color coded with special dyes. A special "map" is made of the treatment area corresponding to the color code used on the removed tissue. The tissue is taken to the laboratory where it is rapidly frozen, cut into thin sections, placed on microscope slides, and stained. Using the microscope, the surgeon determines whether any tumor persists. If an edge of the wound still contains tumor, it is noted on the patient map. That area is then removed in a subsequent stage: the patient is brought back into the surgery suite and, after the administration of additional anesthesia, another layer of tissue is removed from the appropriate location. The entire process is repeated until the physician is satisfied that the base and sides of the wound no longer contain cancerous cells.
The removal and preparation of tissue takes approximately 1 to 2 hours for each layer. You spend only 15 to 30 minutes of that time in the surgical suite. The remainder of time is required for tissue processing and evaluation. The average patient requires 1 to 3 stages for complete removal of the tumor. Therefore, by beginning early in the morning, Mohs surgery is generally completed in one day. Rarely, however, extensive disease may be encountered and require continued surgery on the following day.
Why Choose a Fellowship-Trained Mohs Surgeon?
It's important to choose a specialist who's completed the rigorous fellowship training to become a member of the American College of Mohs Surgery (ACMS). To become a ACMS member, Dr. Lapinski participated in at least 500 Mohs surgery cases, demonstrated the ability to accurately interpret slides of tissue samples removed during Mohs surgery, and performed a range of reconstructive procedures that included complex repairs.
Learn more about the ACMS and how the superior training of its members directly benefits patients.
A Team Approach to Skin Cancer Care
Men and women who choose Pinnacle Dermatology for skin cancer treatment appreciate the unique benefits of Dr. Rios and Dr. Lapinski's comprehensive approach. They perform over 1,800 Mohs surgeries every year and have completed more than 15,000 cases as a team.
"We look at patients from the perspective of our unique specialties — dermatology and plastic surgery — and we use each other's knowledge to provide a better overall treatment experience for them."
— Dr. Jose Rios
The board-certified specialists create a customized treatment plan based on each patient's unique needs. In many cases, patients leave our practice having been both cleared of cancerous cells by Dr. Lapinski, and having their surgical wounds repaired by Dr. Rios. Patients who undergo skin cancer surgery at a dermatology-only practice often leave without this specialized treatment from a plastic surgeon, sometimes with no surgical plan in place and wearing a bandage for a week or more before seeing a plastic surgeon elsewhere.
Instead, our patients treated for skin cancer by Dr. Lapinski have the peace of mind knowing that a board-certified plastic surgeon with Dr. Rios' expertise performs reconstructive surgery to close the wound in a way that will lead to aesthetically pleasing results.
Once all the skin cancer cells have been removed, you will be left with a surgical wound. Several options are available for repair. Your options for reconstructive dermatology in the Naperville area will be discussed with you, and we will recommend the one that can restore as much function as possible to affected structures and provide the best cosmetic result. Some repair options include:
- Spontaneous granulation. Skin tissues have a remarkable capacity to heal themselves and certain areas of the body will heal very nicely, thus requiring no further surgery. This type of healing allows observation when a difficult tumor is involved and recurrence is a consideration. At other times, wounds should be left to heal on their own with plans to use reconstructive surgery to treat the resulting scar at a later date.
- Closing side-to-side with stitches can very often provide excellent cosmetic results. This technique is best used on small defects and when the scar can be hidden in a wrinkle line.
- Skin graft. Grafting involves covering the wound with skin obtained from other parts of the body. Split-thickness skin grafts are thin shavings of skin usually obtained from the thigh. This can be used as permanent coverage or as temporary coverage prior to the final reconstructive procedure. Full-thickness skin grafts require a thicker layer of skin and are usually used as permanent coverage. Skin around the ear or collar bone is removed and stitched to cover the wound. The donor site is then sutured together.
- Skin flaps. Skin flaps involve the movement of nearby or adjacent healthy skin to cover the wound. This form of closure often provides excellent cosmetic results due to the match of skin texture, consistency, and color.
- Consultation with another reconstructive surgeon. If your surgery proves to be extensive or involves significant functional impairment, we will seek the help of a plastic surgeon for reconstruction of the defect. Usually, you will see the surgeon before or on the day that the Mohs surgery is performed, and the final reconstruction will be scheduled on or within a few days of Mohs surgery.
Things to Watch Out for After Mohs Surgery
We ask our patients to look out for a number of things as their body heals following Mohs surgery and to contact us if something seems unusual:
Most patients experience relatively little to moderate pain following surgery. If you do have discomfort, we request that you use acetaminophen (Tylenol®) and ibuprofen (Advil®/Motrin®), if tolerated. We can prescribe a more powerful pain reliever if needed.
Some postoperative bleeding occurs in a small number of patients and is usually controlled with gentle pressure. You may need medical assistance if bleeding persists after applying constant pressure with a gauze pad for 15 to 30 minutes. Bleeding to this extent is rare, but if it occurs, you should call our office and ask to have the doctor paged, or visit a local emergency room.
Swelling and Bruising
Both are commonly seen following Mohs surgery, particularly when treating lesions near the eyes and mouth. Applying cool packs following surgery helps to minimize these problems. Swelling and bruising normally subside within 4 to 7 days.
Most wounds develop redness at the edges as a normal part of healing. However, if the redness does not subside after several days or if you notice warmth, pain, or pus you should immediately notify us or your physician immediately.
Itching and Redness
Reactions to tape or topical ointments or creams are common and can cause itching and redness. Request a non-allergenic tape at the pharmacy if this happens and make us aware of your problem.
Cutting into the skin damages nerve endings which can lead to varying degrees of numbness in the area around the surgery site. This sometimes persists for months or longer and, in some cases, may be permanent. You may notice sensation changes that persist through the first year following surgery, usually representing the regeneration of nerve fibers.
Our doctors make every effort to produce the best possible cosmetic result, but there will be a scar after surgery. You can minimize the scar's appearance by properly caring for the wound. We discuss wound care in detail with you and give you instructions following surgery.
For Consultation and Referral
Board-certified dermatologist Dr. Paula Lapinski completed a fellowship in Mohs micrographic and dermatologic surgery at the University of Texas, and is a member of the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO). Please feel free to learn more about Mohs surgery by visiting the ACMMSCO Website.
To make an appointment with Dr. Lapinski at any of our offices call (815) 744-8554 .