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What is Mohs Surgery?
Mohs surgery is a microscopically guided procedure for skin
cancer removal. It was developed more than 60 years ago by
Fredrick Mohs (pronounced “moze”), a medical student at the
University of Wisconsin. Since that time, the technique has
been advanced and refined. Today, it is considered the
most advanced method for treating skin cancers in cosmetically
sensitive areas and for certain other hard to treat skin
cancers.
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Who performs Mohs Surgery?
Dr. Halpern is a fellowship trained Mohs Surgeon. He
attended Harvard Medical School and completed his residency
in Internal Medicine at Lenox Hill Hospital. He was chief
resident of Dermatology at St. Luke’s Roosevelt
Hospital-Columbia University and completed a 2-year
fellowship in Mohs Surgery and Cutaneous Oncology at New
York Presbyterian Hospital-Columbia University. Dr. Halpern
is Board Certified in Dermatology.
A specialized team of several surgical assistants, a
technician who prepares the tissue for microscopic
examination, and our office staff, assist Dr. Halpern.
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What are the Advantages of Mohs Surgery?
Though most of a skin cancer is usually visible to the naked
eye, microscopic cancer cells may extend outside of the
central tumor. If these extensions are not removed, the skin
cancer may reappear. To guarantee removal of these
microscopic areas, most physicians must remove a wide area
of normal skin around the visible skin cancer. Even with
this safety margin, however, skin cancers removed with
traditional treatments can return or require additional
surgical procedures.
In Mohs Surgery, the tumor-removal process is tracked
microscopically. We are therefore able to best ensure that
the entire skin cancer is cured while at the same time
removing as little normal, healthy skin as possible. This is
particularly important in cosmetically important areas. Of
course, any procedure will leave a scar, but by preserving
the maximum amount of healthy skin Dr. Halpern strives to
offer the best possible cosmetic result.
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How Large Will the Wound Be?
The size and shape of the wound depends upon the extent of
the skin cancer. Though this cannot be predicted before
surgery, it is typically several millimeters wider than the
visible skin cancer.
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How is Mohs Surgery Performed?
Mohs surgery is performed in our office on an outpatient
basis. First, local anesthesia is used to numb the tumor
site. Then, a thin layer of skin is removed, processed in
our office, and examined under the microscope by Dr. Halpern.
If any cancer cells remain, their locations are carefully
diagrammed on a map. Using this map as a guide, another thin
layer of skin will then be removed. Depending on the
branching pattern of the tumor, this process may be repeated
several times.
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How Will the Wound be Repaired?
In some areas of the face, small wounds may look best if
allowed to heal on their own. Most defects, however, require
at least a few small stitches. Larger wounds may need skin
flaps or grafts. Both techniques involve moving healthier
skin into the surgical wound. Unusually large or complicated
tumors may, however, require consultation with another
sub-specialist.
Unfortunately, the type of repair needed for your wound
cannot be determined until the entire skin cancer is
removed. Remember—the primary reason for Mohs Surgery is to
cure the skin cancer. Once this is completed, Dr. Halpern
and our staff will help you to achieve the best cosmetic
outcome possible.
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How Long Will it Take?
Each stage of surgical sampling takes only about 15-20
minutes, though an additional hour is then needed for our
team to process and evaluate your specimen.
Depending on the extent of your skin cancer, this cycle may
need to be repeated several times throughout the morning
until your entire tumor is removed.
In most cases, Dr. Halpern will repair your wound
immediately following surgery, but we may need you to come
back the next day. Depending on the complexity of this
procedure, this step may take between 15 minutes and 1 hour.
Because we cannot predict the size of your skin cancer
before surgery, it is impossible for us to determine how
long the process will take. Please plan to spend your entire
day with us. Hopefully, we will have you home much sooner.
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Will I Need to Come Back?
Usually, only one or two return visits are needed to repair,
remove stitches or examine the healing surgical site.
Afterwards, it is essential that you return to your
referring physician for routine skin examinations.
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What Are the Risks of Mohs?
Scarring: A scar will always occur from surgery. Mohs
surgery should, however, result in the smallest possible
scar. In most cases, scars begin as pink and bumpy and then
fade slowly. Occasionally, minor procedures are used to
improve the scar.
Bleeding: Though more extensive bleeding is always possible,
very minor bleeding during surgery is expected.
Pain: During surgery, pain is limited to the initial needles
needed to introduce local anesthesia. Following surgery,
most patients experience minor discomfort, which can be
controlled by Tylenol.
Infection: Infection following surgery is rare. If an area
does become infected, it can be controlled by oral
antibiotics.
Nerve Damage: Rarely, your skin cancer may be located around
a small nerve. If this does happen, the skin surrounding
your surgery may be numb. In rare cases, your skin cancer
may surround a nerve, which leads to a muscle. If this nerve
is damaged, movement of this muscle may be permanently
impaired.
Recurrence: Mohs surgery offers the highest cure rate of all
skin cancer treatments. Medicine is, however, an imperfect
science. Rarely, a tumor may reappear within the treated
area.
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How Should I Prepare for Surgery?
Medicines: Continue to take all medications as prescribed by
your physician. If you are taking aspirin, Vitamin E, or
other supplements, please stop these for one week prior to
surgery. These may cause increased bleeding. Be sure to take
all of your other medications on the morning of surgery, and
bring any doses that you take during the day with you to our
office.
Alcohol: Alcohol may also cause increased bleeding. Please
avoid alcohol for two days prior to surgery and two days
after surgery.
Transportation: We suggest that you have a companion drive
you to and from our office. You may also be more comfortable
with someone to keep you company in the waiting room.
Meals: On the day of surgery, eat your normal breakfast. We
suggest that you bring lunch with you.
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