Successfully Removing Skin Cancer Through 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”), who was 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.
Who Performs Mohs Surgery?
Dr. Matthew 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. He completed a two-year-fellowship in Mohs Surgery and Cutaneous Oncology at New York Presbyterian-Columbia University. He is Board certified in Dermatology. Dr. Halpern is assisted by a specialized team of surgical assistants, a technician who prepares the tissue for microscopic examination, and our office staff.
The Advantages/Risks of Mohs
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. Most physicians remove a wide area of normal skin around the visible skin cancer. Even with this safety margin 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. 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.
Risks of Mohs surgery are scarring, bleeding, pain, infection, nerve damage and reoccurrence. A scar will always occur from surgery but Mohs surgery should result in the smallest possible scar. Most scars begin as pink and bumpy and then fade slowly. Occasionally, minor procedures are used to improve the scar. Though more extensive bleeding is possible, very minor bleeding during surgery is expected. 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 following surgery is rare, and is usually controlled by antibiotics. Rarely, your skin cancer may be located around a small nerve or muscle. If this does happen, the skin surrounding may be numb. If the nerve is damaged, movement of this muscle may be permanently impaired. Mohs surgery offers the highest cure rate of all skin cancer treatments. Medicine is, however, an imperfect science. Rarely, a tumor may reappear in the treated area.
How is Surgery Performed, How Will it Repair, and How Do I Prepare?
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 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.
In some areas of the face, small wounds may look best if allowed to heal on their own. Most defects 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 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. 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.
Continue to take all medications as prescribed by your physician. If you are taking Fish oil, Vitamin E, or other supplements, please stop those 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 may also cause increased bleeding. Please avoid alcohol for two days prior to surgery and two days after surgery. On the day of surgery, eat your normal breakfast. We suggest that you bring lunch with you, as well as something to read or pass the time.
How Long Will Surgery Take and Will I Need to Come Back
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 fifteen minutes and one 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.
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 your routine skin exams.
How Large Will the Wound Be?
The size and shape of the wound depends upon the extent of the skin cancer. Although this cannot be predicted before surgery, it is typically several millimeters wider than the visible skin cancer.