|Elizabeth A. Spenceri, M.D.
Skin Cancer Specialist
Fellowship-Trained Mohs Surgeon
12200 W. 106th St., Suite 210
Overland Park, KS 66215
Mohs Surgery is a specialized and highly effective technique for removing most types of skin cancer. This technique has two main advantages over other treatment options. First, it allows the surgeon to remove only the smallest amount of tissue necessary. This is called "tissue conservation" and is especially important in areas where there's not much tissue to spare, such as around the eye, nose, ear, or lips. Second, this technique yields the highest cure rates (around 96-99%) of all the treatment options for skin cancer.
Frequently Asked Questions about Mohs Surgery:
How is it performed?
What types of skin cancer are treated with Mohs Surgery?
Since my biopsy, I can hardly see where the spot was. Do I still need surgery?
How long will the surgery take?
How do I prepare for surgery?
Will I need plastic surgery after the skin cancer is removed?
Will Mohs Surgery leave a scar?
What is the recovery period for Mohs Surgery?
Are there any follow up visits needed?
What are the chances that the skin cancer will return?
Will my insurance cover the cost of the surgery?
Once the skin cancer site is confirmed and numbed using local anesthetic, a thin layer of tissue is removed around the biopsy site/skin cancer. The tissue is oriented using special inks, and a corresponding map is drawn of the tissue. The tissue is processed on site, and the Mohs surgeon examines it under the microscope. If any roots of skin cancer are identified during the microscopic examination, they are noted on the map.
The patient is then brought back in the surgery room, and additional tissue is removed only in the areas where skin cancer cells remain. The map is used to determine exactly where to take more tissue. The process continues until no further skin cancer is identified under the microscope.
Once all the skin cancer cells have been removed, the doctor and patient review the options for reconstruction. These options may include simple stitches (or a "primary closure"), a skin flap, a skin graft, or letting the area heal on its own (also known as "secondary intention").
There are certain types of skin cancer that are best treated with Mohs surgery. These include non-melanoma skin cancers (such as basal cell carcinoma and squamous cell carcinoma) on the head or neck, those with aggressive features noted upon biopsy, large skin cancers, and skin cancers that have recurred after previous treatment. Patients who are immunocompromised or have had many previous skin cancers are also ideal candidates because their skin cancers have a greater chance of being aggressive or extensive. Similarly, patients with Nevoid Basal Cell Carcinoma Syndrome (NBCCS) who require surgery are appropriate candidates for Mohs surgery.
A biopsy is often performed to establish a diagnosis, not to completely remove a skin cancer. Unfortunately, many skin cancers have microscopic roots that would continue to grow under the surface of the skin if left untreated. Most dermatologists agree that definitive treatment (e.g. surgery, radiation, etc.) be performed of any biopsy-proven skin cancer once the diagnosis is made to allow for optimal cure rates.
You should plan on being in the office for the better part of the day. Each "layer" of tissue can take about an hour on average to be processed and examined. While you are waiting, you can relax in our Mohs waiting area. Feel free to bring a visitor to keep you company while you wait.
You are able to eat breakfast and lunch as well as snacks on the day of surgery unless otherwise instructed by the doctor. Please take all of your normal medications unless the doctor has advised you otherwise.
As a fellowship trained Mohs surgeon, Dr. Spenceri is extensively trained in skin cancer reconstruction. Dr. Spenceri will review the anticipated reconstruction options with you both at the time of consultation and on the day of surgery. In some instances, such as with very large skin cancers, Dr. Spenceri may coordinate the Mohs surgery with reconstruction by a plastic surgeon or head and neck specialist.
Any surgical removal of skin cancer will leave a scar. With Mohs surgery, the amount of tissue removed during the skin cancer surgery is minimized. Small margins are used and the mapping/tracking technique ensures additional layers are only taken where necessary.
After Mohs surgery confirms all skin cancer cells are removed, the Mohs surgeon will discuss the best options for reconstruction and wound care to ensure the final scar is as minimally noticeable as possible. Scar massage after the wound fully heals is another way to improve scar appearance over time. This is often discussed at your follow-up visit.
Most stitches will need to be removed between 6 to 14 days. You should try to "take it easy" during this immediate post-operative period as far as exercise and strenuous activity are concerned. You can usually resume your normal bathing routine within 48 hours.
Additional follow-up visits are determined on an individual basis. Usually, at least one follow-up visit for stitch removal or wound check is recommended between 1 to 4 weeks after surgery with either the nursing staff or Mohs surgeon. Once the wound is fully healed, you will be able to follow up with your dermatologist or referring provider for routine skin checks.
There is a 1-4 % chance that a basal cell carcinoma or squamous cell carcinoma, treated with Mohs surgery, will recur. These are the lowest recurrence rates of any of the treatment options. Some skin cancers are inherently more aggressive and have a greater risk of recurring around the scar tissue or possibly spreading to other parts of the body. Dr. Spenceri will review any of these concerning features with you during your consultation and surgery date.
Because Mohs surgery is a proven, preferred way of treating many skin cancers, essentially all insurance companies will cover the cost of the surgery and the subsequent reconstruction. Of course, any necessary co-payments, deductibles, or coinsurance are considered by the insurance carriers to be the patient's responsibility. Feel free to discuss any insurance or billing question with our patient coordinator or billing staff.
Form more information on Mohs Surgery visit www.skincancermohssurgery.org.