804-855-0372
7001 Forest Ave., Suite 301, Richmond, VA 23230

ABOUT MOHS'

Mohs' Micrographic Surgery or "Mohs" is a specialized technique named after Dr. Frederick Mohs who pioneered the technique as a medical student in the 1930s. Since Dr. Mohs' original work, the technique has undergone modification to become the advanced technique used today. Mohs is a highly specialized procedure which requires extensive training in surgery and histopathology.

Use of this technique enables Mohs surgeons to remove skin cancer with maximal preservation of normal tissue and the highest cure rate possible. We offer streamlined treatment for patients who have a history of multiple cutaneous cancers.

WHY SKIN CANCER SHOULD BE TREATED

Basel cell carcinoma and squamous cell carcinoma are the two most common types of skin cancer treated by Mohs surgery. Basel cell carcinomas are the most common cancer in the United States, they are locally invasive and destructive tumors. This can lead to serious health issues if the tumor is neglected for long periods of time. In extremely rare cases basel cell carcinomas can spread to other sites.

Squamous cell carcinomas are different from basel cell carcinomas in that they have a higher potential to spread to other areas of the body. Although there is this potential, the vast majority of cases are readily treated and cured with skin surgery such as Mohs.

TREATMENT OPTIONS

In addition to Mohs, certain skin cancers can be successfully treated with the following methods; simple excision, electrodessication and curettage, radiation therapy, topical immunomodulators and cryosurgery. The cure rate of these methods is typically lower than Mohs, although they may be appropriate in certain circumstances. Mohs surgery typically provides a 95-98% rate of cure. Importantly, it strives to ensure that the tumor is entirely removed before the repair is done. Because the Mohs technique allows for less uninvolved tissue to be removed than traditional surgical options, there is more normal tissue available for reconstruction following tumor removal.

WHAT TO EXPECT ON THE DAY OF MOHS SURGERY

Upon your arrival, Dr. Fisher will examine you and discuss the proposed treatment. Then the site is numbed with local anesthesia, and the visibly involved tissue is carefully removed. This layer of skin is diagrammed and mapped using special inking and nicking procedures. Then, a specially trained technician prepares the tissue so it can be examined by the surgeon under the microscope. If there is a tumor, scar, or other concerning finding at the surgical margin, the surgeon uses the carefully prepared map to direct a subsequent stage(s) of surgery to the area(s) of concern. The process is repeated until clean margins are achieved. Following the removal of the tumor, Dr. Fisher will review and discuss options for closure. The closure will be done at that time in the majority of cases. Most patients spend three to five hours total time in the office, but you should be prepared to spend the entire day as a precaution. In addition, we strongly recommend that you have someone with you during the day who can drive you home following surgery.

THE POST-OPERATIVE PERIOD

Temporary discomfort, bruising, and swelling is common. Some people can return to work soon following surgery, but this cannot be guaranteed. It is strongly suggested that the patient "take it easy" for several days after surgery and avoid jobs or hobbies that involve heavy lifting. Following Mohs, a follow-up visit will often be needed for suture removal. Additional visits are indicated in some cases.

LONG TERM MANAGEMENT

After Mohs, regular skin examinations with your general dermatologist are recommended. Also, it is never too late to implement a program of sun protection that includes use of sun protective clothing, sun block and limiting outside activities during the peak sun hours, 10 a.m. until 4 p.m. We also offer several rejuvenating procedures that have been shown to diminish solar damage, playing an added role in your long term skin management. Rejuvenating procedures are not covered by your insurance company at this time.