|
Mohs
F.A.Q.
What
is
skin
cancer?
What
are
Basal
Cell
and
Squamous
Cell
Carcinoma?
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?
Billing
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
cancer
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.
In the
Mohs’
Surgery
Clinics
we
treat
basal
cell
carcinomas,
squamous cell carcinomas, and some much rarer skin tumors. 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 which slowly
enlarges.
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to Top
What
are
Basal
Cell
and
Squamous
Cell
Carcinoma?
Back
to Top
Both
of
these
cancers
behave
and
are
treated
in a
similar
manner.
Their
difference
lies
in the
cell
from
which
they
originate
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.
Both
basal
cell
carcinoma
and
squamous
cell
carcinoma 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,
which
includes
physicians,
nurses,
and a
technician.
The
physician
heading
the
team
has
had
surgical
training
in the
technique.
The
nurse
is an
important
part
of the
team
who
will
help
answer
your
questions,
responds
to
your
anxieties,
assists
in
surgery,
and
instructs
you in
dressings
and
would
care
after
the
surgery
is
performed.
A
technician,
whom
you
may
not
even
meet,
performs
the
essential
task
of
preparing
the
tissue
slides
that
are
examined
under
a
microscope
by the
physician.
The
word
"chemosurgery"
as
used
today
is
really
a
misnomer.
When
Dr.
Mohs
initially
introduced
the
procedure,
he
applied
a
chemical
(zinc
chloride)
to the
tumor
and
surrounding
skin,
which
fixed
the
tissue
prior
to its
removal.
In the
last
10
years,
the
procedure
has
been
refined
and
improved
upon
so
that
most
cases
are
done
using
fresh
tissue
(omitting
the
chemical
paste).
The
name
given
to the
original
technique
is
Mohs’
Chemosurgery:
fixed
tissue
technique.
The
majority
of
cases
today
are
done
using Mohs’
Chemosurgery:
fresh
tissue
modification.
We
prefer
to
drop
the
"chemo",
calling
the
technique
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.
The
physician
will
then
examine
the
slides
under
the
microscope
and be
able
to
tell
if any
tumor
is
still
present.
If
cancer
cells
remain,
he is
able
to
exactly
locate
them
based
upon
his
map.
Another
layer
of
tissue
is
then
removed
and
the
procedure
is
repeated
until
the
physician
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
of
each
layer
of
tissue
takes
approximately
one to
two
hours.
Only
20 to
30
minutes
of
that
is
spent
in the
actual
surgical
procedure,
the
remaining
time
being
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
dealt
with
in one
of
several
ways.
The
several
options
will
be
discussed
with
you in
order
to
provide
the
best
possible
cosmetic
results
without
disguising
the
small
possibility
of
recurrence.
The
possibilities
explained
below
include:
1.
Healing
by
spontaneous
granulation;
2.
Closing
the
wound,
or
part
of the
wound
with
stitches;
3.
Using
a skin
graft;
4.
Using
a skin
flap;
or 5.
Arranging
a
consultation
with a
surgeon
who
specializes
in
more
complicated
surgical
repairs.
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
cosmetic
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
provides
a
thicker
layer
of
skin
to
achieve
proper
results.
In
this
instance,
skin
is
usually
removed
from
behind
the
ear or
around
the
collarbone
(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 is
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
surgeon),
he or
she
will
take
care
of you
after
your
cancer
has
been
removed.
In
summary,
by
microscopically
pinpointing,
areas
involved
with
cancer
and
selectively
removing
these
tissues,
the
Mohs’
surgeon
can
successfully
remove
your
skin
cancer.
Because
normal
tissue
is
preserved
to the
greatest
extent
possible,
the
Mohs’
surgeon
is
able
to
offer
you
the
possibility
of a
good
cosmetic
result.
Although
an
attempt
will
be
made
to
minimize
the
scar,
you
will
be
left
with a
scar
of
some
kind.
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to Top
How do
I
prepare
for
the
day of
surgery?
Back
to Top
The
best
preparation
for
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
a book
or
magazine
to
read.
Also,
because
the
day
may
prove
to be
quite
tiring,
it is
advisable
to
have
someone
accompany
you on
the
day of
surgery
to
provide
companionship
and to
drive
home.
Your
referring
physician
may
request
that
you
have a
preoperative
visit
to
evaluate
the
need
for
Mohs’
Surgery.
At
this
visit,
the
technique
will
be
discussed
in
detail,
you
will
meet
the
"team"
performing
the
surgery,
and a
biopsy
may be
performed.
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.
If
this
is the
case,
and
you
have
never
been a
patient
at
Somerset
Skin
Centre
before,
you
should
plan
to
arrive
20 to
30
minutes
before
your
scheduled
appointment
in
order
to
register.
If you
take
any
medications,
bring
them
with
you in
their
labeled
bottles
or
tubes.
We
request
that
you
stop
taking
any
aspirin
or
aspirin
containing
compounds
(like
Anacin,
Bufferin,
or
Ascriptin)
at
least
a week
before
your
surgery.
This
is
because
they
may
interfere
with
the
normal
blood
clotting
mechanism,
making
you
bleed
more
than
normal
during
surgery.
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What
happens
the
day of
surgery?
Back
to Top
Your
appointment
has
purposely
been
scheduled
early
in the
day.
When
the
surgical
suite
becomes
available,
our
nurse
will
escort
you to
that
area
of the
clinic.
After
preliminary
preparation
of the
skin,
you
will
be
placed
on the
surgical table
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
placed
over
your
surgical
wound
and
you
will
be
free
to
leave
the
surgical
suite.
On the
average,
it
takes
an
hour
for
the
slides
to be
prepared
and
studied.
During
this
time
you
may
wait
in the
waiting
room,
read
your
book
or
magazine,
or
take a
walk
around
the
medical
center.
Most
Mohs
Surgery
cases
are
completed
in two
or
three
stages.
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.
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to Top
What
can I
expect
after
the
surgery
is
complete?
Back
to Top
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
painkiller
(Datril).
Rarely,
a
stronger
pain
medicine
will
be
prescribed.
Bleeding
A small number of patients will experience some bleeding post operatively.
This bleeding 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. If bleeding persists after continued pressure for 15 minutes, repeat
the pressure for another 15 minutes. If this fails, call your physician or
visit a local urgent care facility.
Complications
There
are
some
minor
complications
which
may
occur
after
Mohs’
Surgery.
A
small
red
area
may
develop
surrounding
your
wound.
This
is
normal
and
does
not
necessarily
indicate
infection.
However,
if
this
redness
does
not
subside
in two
days
or the
wound
begins
to
drain
pus,
you
should
notify
your
physician
immediately.
Itching
and
redness
around
the
wound,
especially
in
areas
where
adhesive
tape
has
been
applied,
are
not
uncommon.
When
this
occurs,
ask
your
druggist
for a
non-allergenic
tape
and
tell
us on
your
return
visit,
Swelling
and
Bruising
are
very
common
following
Mohs’
Surgery,
particularly
when
it is
performed
around
the
eyes.
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.
At
times,
the
area
surrounding
your
operative
site
will
be
numb
to the
touch.
This
area
of
anesthesia
(numbness)
may
persist
for
several
months
or
longer.
In
some
instances,
it may
be
permanent.
If
this
occurs,
please
discuss
it
with
your
physician
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
Wound
Care
Information
Sheets
which
will
explicitly
outline
how to
take
care
of
whatever
type
of
wound
you
have.
Most
Mohs
Surgery
cases
are
completed
in two
or
three
stages.
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.
Back
to Top
Will I
develop
more
skin
cancers?
Back
to Top
After
having
one
skin
cancer,
statistics
say
that
you
have a
higher
chance
of
developing
a
second.
The
damage
which
your
skin
has
already
received
from
the
sun
cannot
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
(suntan
lotion)
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
#15 or
higher
sunscreen.
Despite
manufacturers'
claims,
we
recommend
that
you
reapply
sunscreen
after
swimming.
A wide
brimmed
hat,
long-sleeved
shirt
and
other
protective
clothing
are
also
appropriate.
Avoidance
of
excessive
sunshine
is
recommended.
You
should
have
your
skin
checked
very
closely
by a
physician
at
six-month
intervals.
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
six-month
follow-up
visits
for
two
years,
then
yearly.
Of
course,
any
areas
of
your
skin
that
change,
fail
to
heal,
or
just
concern
you
should
be
brought
to the
attention
of
your
referring
physician
immediately.
He/She
will
be
able
to
adequately
treat
most
skin
cancers
when
they
are
detected
early
and
are
small.
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Billing
Back
to Top
Billing
for
Somerset
Skin
Centre
is
based
on a
standard
fee
schedule
dictated
by
Medicare
and
the
insurance
companies.
Coverage
will
depend
on
your
insurance
plan.
Should
you
have
any
questions
regarding
coverage,
please
contact
your
insurance
company
for
assistance.
If you
are
being
referred
under
a
prepaid
insurance
program,
such
as a
health
maintenance
organization
(HMO),
we are
not
permitted
to
treat
any
condition
that
has
not
been
specifically
requested
by
your
primary
care
physician.
Please
make
sure
to
have
the
referral
information
taken
care
of
before
your
appointment
to
prevent
any
unnecessary
delays.
If you
have
any
questions
regarding
the
billing,
please
call
our
office
at
248-244-8448.
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