Mohs Micrographic Surgery

Preserve Healthy Tissue

If you have skin cancers such as basal cell carcinoma or squamous cell carcinoma, we may recommend removing your cancer with Mohs Micrographic Surgery. Dr. Frederic Mohs of Madison, Wisconsin, developed this highly specialized technique more than 70 years ago to remove skin cancer while preserving healthy tissue.

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What is Mohs Micrographic Surgery?

With this technique, we remove the cancer one layer at a time and examine the tissue while you wait to make sure the entire cancer has been removed. By working with one layer at a time, we can remove the entire cancer while preserving as much healthy tissue as possible.

Mohs Micrographic Surgery involves these critical components:

Removal of the layer of skin cancer
Review the specimen under the microscope

Repeat removal and examination as many times as needed
Reconstruction of the defect

Dermatology specialists prefer this technique when the tumor is located on the head and neck or other sensitive areas such as the hands and feet, large cancers, for cancers that have come back after prior removal, or when the type of skin cancer is aggressive. Of all treatment options for skin cancer, Mohs Micrographic Surgery:

Offers the highest cure rate (up to 99%)
Has the lowest chance of regrowth
Minimizes the potential for scarring or disfigurement
Is the most exact and precise means of removal

To optimally perform Mohs Micrographic Surgery, a dermatologist must be formally trained in a one or two year program and accredited by the American College of Mohs Surgery (ACMS). Feel free to ask our specialists about formal training and their membership status with the ACMS.

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Learn More About
Mohs Micrographic Surgery

Am I a Good Candidate?

HOW DOES MOHS SURGERY WORK?

HOW DO I PREPARE FOR MOHS SURGERY?

WHAT IS RECOVERY LIKE?

You may be a candidate for Mohs Micrographic Surgery if you have been diagnosed with nonmelanoma skin cancer such as basal cell carcinoma or squamous cell carcinoma, if your skin cancer is recurring and other methods have not effectively stopped it, or it’s located in a spot with thin tissues around it, such as the ear, foot, or nose.

If your skin cancer is aggressive, Mohs surgery may also be your best treatment option. A Levy Dermatologist can determine if Mohs is your treatment of choice during a consultation.

At Levy Dermatology, we perform this surgery on an outpatient basis and under local anesthesia. We numb the area and remove the visible tumor. After this, we remove a thin layer of skin with a scalpel. We examine the tissue under a microscope. If we see cancer cells, we remove another layer of skin. We continue this process until cancer cells are no longer present.

Once we remove the cancer, we determine the best plan for wound reconstruction and closure. The type of repair depends on the shape, size, depth, and location of the wound. Sometimes we can close the defect with sutures. Sometimes a skin flap or skin graft may be necessary.

We often repair wounds the same day as the surgery. Other times the repair is delayed. Rarely, a staged repair requiring a series of procedures over weeks or months may be required. In almost all cases, we perform the repair in our office operatory.

  • With this procedure, it is impossible to anticipate how much time is required. To reduce stress, clear your calendar for the day and plan to spend it with us.
  • Bring reading material or personal devices to occupy your time while waiting for the microscopic slides to be processed and examined.
  • Arrive 15 minutes prior to your appointment to allow time to complete medical forms.
  • Arrange to have a companion drive you to and from the doctor’s office. We do ask that you bring no more than one person with you, as seating is limited and social distancing protocols are strictly adhered to.
  • We provide magazines, bottled water, and snacks.

 

We recommend antibiotics 30 to 60 minutes prior to your surgery if any of these circumstances apply:

  • Joint replacement surgery within the past year
  • An artificial heart or heart valves
  • History of endocarditis/infected heart valves
  • Severe dysfunction of a heart valve

 

If these situations apply, we can prescribe an appropriate antibiotic. Please call the office at least two to three days before your appointment to request a prescription.

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For optimal healing after Mohs Micrographic Surgery and facial reconstructive surgery, please do the following:

Before Surgery

  • Quit smoking. Tobacco use impairs healing and can result in more severe scarring.
  • Avoid blood-thinning medication and supplements — aspirin, ibuprofen, vitamin E, and fish oil — unless a physician specifically prescribed them for you.
  • Take any prescribed antibiotics as instructed.
  • Refrain from drinking alcohol three days prior to and three days after your appointment. Alcohol increases your risk of bleeding.

The Day of Your Surgery

  • Eat your normal breakfast on the day of surgery

 

Following Your Surgery

  • Avoid excessive lifting and physical activity
  • Follow your post-operative instructions
  • If you do not understand your instructions, please ask us!
  • Attend your follow-up appointments as scheduled

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During your treatment, a local anesthesia (lidocaine) will block pain. There will be some pain associated with the initial injection. You should expect mild-to-moderate pain beginning several hours after surgery, which usually resolves over 24-48 hours. For most patients, acetaminophen, ibuprofen, or naproxen provides adequate pain control. Applying ice packs over the bandage at the surgical site can reduce pain, swelling, and bruising but are usually not necessary.

Wound care varies depending on the type of closure and will be thoroughly explained to you after surgery. In most cases, minimal wound care will be needed as the wound will be covered with a sterile dressing that lasts until the time of suture removal. In other cases, daily dressing changes may be recommended. Depending on the location of your skin cancer and whether or not sutures are placed on the skin surface, you can expect to return for follow up in 7-14 days at which time sutures will be removed and/or the wound reassessed.

You may be a candidate for Mohs Micrographic Surgery if you have been diagnosed with nonmelanoma skin cancer such as basal cell carcinoma or squamous cell carcinoma, if your skin cancer is recurring and other methods have not effectively stopped it, or it’s located in a spot with thin tissues around it, such as the ear, foot, or nose.

If your skin cancer is aggressive, Mohs surgery may also be your best treatment option. A Levy Dermatologist can determine if Mohs is your treatment of choice during a consultation.

At Levy Dermatology, we perform this surgery on an outpatient basis and under local anesthesia. We numb the area and remove the visible tumor. After this, we remove a thin layer of skin with a scalpel. We examine the tissue under a microscope. If we see cancer cells, we remove another layer of skin. We continue this process until cancer cells are no longer present.

Once we remove the cancer, we determine the best plan for wound reconstruction and closure. The type of repair depends on the shape, size, depth, and location of the wound. Sometimes we can close the defect with sutures. Sometimes a skin flap or skin graft may be necessary.

We often repair wounds the same day as the surgery. Other times the repair is delayed. Rarely, a staged repair requiring a series of procedures over weeks or months may be required. In almost all cases, we perform the repair in our office operatory.

  • With this procedure, it is impossible to anticipate how much time is required. To reduce stress, clear your calendar for the day and plan to spend it with us.
  • Bring reading material or personal devices to occupy your time while waiting for the microscopic slides to be processed and examined.
  • Arrive 15 minutes prior to your appointment to allow time to complete medical forms.
  • Arrange to have a companion drive you to and from the doctor’s office. We do ask that you bring no more than one person with you, as seating is limited and social distancing protocols are strictly adhered to.
  • We provide magazines, bottled water, and snacks.

 

We recommend antibiotics 30 to 60 minutes prior to your surgery if any of these circumstances apply:

  • Joint replacement surgery within the past year
  • An artificial heart or heart valves
  • History of endocarditis/infected heart valves
  • Severe dysfunction of a heart valve

 

If these situations apply, we can prescribe an appropriate antibiotic. Please call the office at least two to three days before your appointment to request a prescription.

Read More

For optimal healing after Mohs Micrographic Surgery and facial reconstructive surgery, please do the following:

Before Surgery

  • Quit smoking. Tobacco use impairs healing and can result in more severe scarring.
  • Avoid blood-thinning medication and supplements — aspirin, ibuprofen, vitamin E, and fish oil — unless a physician specifically prescribed them for you.
  • Take any prescribed antibiotics as instructed.
  • Refrain from drinking alcohol three days prior to and three days after your appointment. Alcohol increases your risk of bleeding.

The Day of Your Surgery

  • Eat your normal breakfast on the day of surgery

 

Following Your Surgery

  • Avoid excessive lifting and physical activity
  • Follow your post-operative instructions
  • If you do not understand your instructions, please ask us!
  • Attend your follow-up appointments as scheduled

Read More

During your treatment, a local anesthesia (lidocaine) will block pain. There will be some pain associated with the initial injection. You should expect mild-to-moderate pain beginning several hours after surgery, which usually resolves over 24-48 hours. For most patients, acetaminophen, ibuprofen, or naproxen provides adequate pain control. Applying ice packs over the bandage at the surgical site can reduce pain, swelling, and bruising but are usually not necessary.

Wound care varies depending on the type of closure and will be thoroughly explained to you after surgery. In most cases, minimal wound care will be needed as the wound will be covered with a sterile dressing that lasts until the time of suture removal. In other cases, daily dressing changes may be recommended. Depending on the location of your skin cancer and whether or not sutures are placed on the skin surface, you can expect to return for follow up in 7-14 days at which time sutures will be removed and/or the wound reassessed.

Consultations Are Available Now

Learn more about our medical and cosmetic dermatology services today. Simply fill out the form on this page, and one of our highly trained medical staff at Levy Dermatology will reach out to you promptly to schedule your consultation.

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