Mohs Surgery & Skin Cancer - Rochester Dermatologic Surgery | Surgical & Aesthetic Dermatology

MOHS SURGERY & SKIN CANCER

You've Come to the Right Place

Now that you have been diagnosed with skin cancer, it is time to seek treatment. At Rochester Dermatologic Surgery, we are specialists who have devoted our careers to the diagnosis, treatment, and prevention of skin cancer. We are committed to making sure that your skin cancer is completely cured and that the permanent effects on your skin and your life are minimal. Although your spot may seem small, one of the most common things we hear from patients is that they didn’t feel prepared for what was entailed with its removal. Please use this guide to help you prepare for your visit.

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Your Visit

The initial part of your visit will consist of a consultation with your physician so that you better understand the nature of your diagnosis, what it means to your health, and the most effective treatment options available.

If you haven’t had a prior consultation, it is impossible for us to be certain of your needs until we meet and formulate a treatment plan.

Although we see and treat thousands of skin cancers each year, this may be your first, and we will take the time to help you understand all aspects of the condition and its management.

At the same time, we know that your time is valuable and that trips to the doctor can be expensive, so we always aim to provide treatment at the same visit as your consultation if this fits with your life and your schedule. However, in certain situations, this may not be possible.

Many skin cancers we see are treated by a procedure known as Mohs micrographic surgery, or simply, Mohs surgery

Mohs surgery is a meticulous approach to ensure that skin cancers are completely removed (with over 99% certainty) and to preserve as much of the uninvolved skin as possible. In some cases, Mohs surgery may not be the best technique to treat your cancer.

For growths on the torso or extremities, we may use techniques such as standard excision (surgical removal followed by immediate suturing), electrodesiccation and curettage (“scrape and burn” procedure), cryosurgery, for certain period after medication. In some situations, there may be a clearly superior method, while in others we may have more than one choice.

In every case, we will discuss these options with you in depth and determine the best course of treatment to ensure that your skin cancer is adequately treated. For some more serious cancers such as melanoma or Merkel cell carcinoma, there are national guidelines that dictate the appropriate treatment.

Regardless, of the type of treatment you will undergo, it is best to come prepared

Because of the careful way we check the removed skin under the microscope while you wait, Mohs procedures take significantly more time than other treatment methods.

Thus, unless you have had a consultation prior to your day of treatment, it is best to come prepared for any approach we may take. Also, just because you are scheduled for Mohs surgery, this does not mean you will necessarily have this procedure.

The ultimate decision will depend on many factors that your physician will discuss with you.

How To Prepare

Mohs Micrographic Surgery

Mohs surgery is a delicate, intricate, and highly effective treatment for skin cancer.

While many physicians may perform Mohs surgery, not all providers are fellows of the American College of Mohs Surgery and the American Board of Dermatology.

By choosing a double board-certified, fellowship-trained Mohs surgeon you can be assured that you will receive the highest standard of quality and competency as well as an optimal outcome.

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The visible tumor and a small segment
of surrounding skin are removed.
The tissue is examined under a microscope
to see if any cancer cells remain at any of the edges.
If any cancer remains, additional skin continues to be removed
and examined under the microscope.
This process continues until no more cancer cells are found.

The visible tumor and a small segment of surrounding skin are removed.
The tissue is examined under a microscope to see if any cancer cells remain at any of the edges.
If any cancer remains, additional skin continues to be removed and examined under the microscope.
This process continues over and over again until no more cancer cells are found.

Mohs Micrographic Surgery

Mohs surgery is a delicate, intricate and highly effective treatment for skin cancer. While many physicians may perform Mohs surgery, not all providers are fellows of the American College of Mohs surgery of the American Board of Dermatology.

By choosing a board-certified, fellowship-trained Mohs surgeon you can be assured that you will receive the highest standard of quality and competency as well as an optimal outcome.

Watch Video

Types of Reconstruction

Once your skin cancer has been removed by the Mohs surgery technique, there will be an area of skin that needs to be repaired, or reconstructed, with sutures (stitches). This part of the procedure can, at times, be very involved to ensure the best functional and cosmetic outcome. The physicians at Rochester Dermatologic Surgery have undergone rigorous fellowship training in the techniques of facial reconstruction. Below are the most common approaches to repairing the skin once a skin cancer has been successfully removed:

Primary Closure

Healing by Granulation or Simply “Letting It Heal”

Skin Grafts

Flap Repair

Outside Provider

If the area in need of reconstruction is very extensive or complex, we may recommend that you see one of our partner providers such as a plastic, facial plastic, or oculoplastic plastic surgeon. If your referring physician specializes in reconstruction, the Mohs surgery component of your visit will be performed at our office, and you will typically see them for your reconstruction on the following day.

Upon completion of your procedure, our nursing staff will review your discharge instructions in depth. This will include options for pain control, appropriate wound care, and signs of potential complications. An on-call provider is available at all times after hours. In some cases, you will return to the office for a post-operative check between 1-3 weeks. Repairs using flaps or grafts may require multiple follow-up visits to ensure proper healing.

Frequently Asked Questions

The following list is designed to help you understand your diagnosis, options for treatment, details of Mohs surgery, how to prepare for your procedure, and what to expect once your treatment has been completed.

What is skin cancer?

Over 99% of skin cancers are a result of damage to cells in the outer layer of the skin resulting from exposure to ultraviolet (UV) radiation, typically from the sun.

This damage alters the DNA in our skin cells and allows them to grow, at an uncontrolled and unpredictable rate. As the skin cancers grow, they destroy the surrounding normal structures.

If left untreated, they can continue to grow invade deeply and on rare occasions, certain types of skin cancer can leave the skin and travel to other parts of the body.

What are the most common forms of skin cancer?

The most common type of skin cancer is basal (“BAY-ZAL”) cell carcinoma, followed by squamous (“SKWAY-MUSS”) cell carcinoma and melanoma.

These three types of skin cancer account for 99% of all cases, however there are over 100 other less common forms of skin cancer.

No matter what type of skin cancer you have been diagnosed with, the physicians at Rochester Dermatologic Surgery will be able to guide you through your management decisions and ensure you receive the best treatment.

Where do the names of skin cancer types come from?

Types of skin cancer are defined and named by the type of cell they arise from. Because almost all skin cancer is a result of UV exposure (typically from the sun), they start in the outermost layer of the skin, the epidermis.

Under the microscope, the epidermis resembles a brick wall, with each brick representing an individual skin cell. Basal cell cancer arises from the basal, or lowest, layer of cells in the epidermis. The word squamous (“SKWAY-MUSS”) in medicine means “flat”. The cells in the epidermis above the basal layer are known as the squamous cells.

The third most common type of skin cancer, melanoma, arises from the pigment producing cells in the epidermis called melanocytes.

Can my skin cancer turn into a different type of skin cancer?

What do skin cancers look like?

Basal cell cancer (BCC) and squamous cell cancer (SCC) can have similar features when they appear on the skin.

We often ask patients what their spot looked like when it first appeared, and the most common answer is, “I thought it was a pimple, but it just never went away.”

BCC and SCC can appear as a pink or skin colored bump on the skin, often with small overlying blood vessels (spider veins). This bump can become scaly or crusty and will occasionally bleed with minimal provocation.

Melanoma can look like a dark spot on the skin with irregular shape and jagged borders.

What is the difference between basal cell cancer and squamous cell cancer?

Basal cell cancer (BCC) and squamous cell cancer (SCC) both arise from similar types of cells in the epidermis and can have a similar appearance. BCC's appear and grow slowly over time and are usually painless, whereas, a SCC can sometimes grow quickly and are occasionally painful. BCC rarely, if ever, metastasizes (spreads internally through the blood or lymph system) but left untreated can grow deeper and be very locally destructive. On rare occasion, certain high-risk SCC’s can spread internally. Thus, all types of skin cancer need to be treated.

Ever since it was biopsied, my spot looks and feels better than it has in a long time. Do I still need surgery?

A skin biopsy is a diagnostic procedure, not a therapeutic procedure. In other words, a biopsy is only meant to take a small piece of the growth so that a diagnosis can be made, it is not meant to be treatment for the growth. As skin cancers grow upward above the skin, they also grow below the surface of the skin, sometimes sending small projections (“roots”) outward and/or downward. Without careful examination of the edges (margins) of what is removed under a microscope, it is impossible to determine if your skin cancer has been fully treated. We know based on previous studies that a biopsy rarely removes the whole cancer, no matter how well it looks to the naked eye. The advantage of Mohs surgery is that we only have to remove what is left of the skin cancer and minimize removal of normal skin. After a biopsy, things may look better, but it is only a matter of time until things begin to visibly worsen.

How is skin cancer treated?

Are there options for treatment other than Mohs surgery?

There are many other ways to treat skin cancer besides Mohs surgery.

These include elecrodesiccation and curettage (ED&C, or a ‘scrape and burn’ procedure), cryotherapy (freezing), radiation, standard excision, oral or IV medications, and topical agents (creams). In some situations these approaches are used.

However, none of them have the high cure rate of Mohs surgery because they lack the careful microscopic examination to ensure that the skin cancer has been completely removed.

What does the word “Mohs” mean?

Mohs micrographic surgery, or simply Mohs surgery, is named in honor of Dr. Frederic Mohs, the physician who first developed the technique over 80 years ago. It has since undergone many technical improvements and refinements to make it an extremely safe and effective method for the treatment of skin cancer. In Mohs surgery, the treating physician is both surgeon and pathologist, allowing for meticulous microscopic inspection of the skin to ensure that the skin cancer is completely removed.

What kind of anesthetic will be used for my Mohs surgery procedure?

I have an allergy to lidocaine, are there other options for numbing medicine?

Will I be ‘knocked out’ for my procedure?

What are the chances that my skin cancer will come back after Mohs surgery?

The cure rate for Mohs surgery approaches 100%. While nothing in medicine can ever be 100%, we see less than 1 in 100 skin cancers recurring (coming back in the exact same spot) after treatment with Mohs surgery. Unfortunately, patients who have had one skin cancer, are at high risk for the occurrence of additional skin cancers over the course of their lives. Your physician and staff at Rochester Dermatologic Surgery will counsel you on things to look for to catch new skin cancers in an early stage and how to best protect your skin from the harmful rays of the sun.

Do I need to see a plastic surgeon to repair my skin?

Your Mohs surgeon has undergone extensive training in facial reconstructive surgery. While 98% of skin cancers we treat at RDS are repaired at our office using the same techniques used in plastic surgery, we do occasionally enlist the help of our colleagues in plastic surgery, facial plastic surgery (ENT), and oculoplastic surgery for more extensive procedures. We have good working relationships with our colleagues in the area. Often times, your plastic surgeon will refer you to RDS for removal of your skin cancer to ensure that it is completely removed, and you will return to your plastic surgeon for reconstruction. If you have a plastic surgeon that you wish to work with, please let us know when scheduling your appointment, so we can arrange care appropriately.

Can I transfer all of my dermatologic care to Rochester Dermatologic Surgery?

The physicians at RDS specialize exclusively in the treatment of skin cancer and do not offer skin cancer screenings or 'skin checks'.

For individuals seeking these essential services, we recommend visiting victordermatology.com to schedule an appointment for a skin cancer screening.

We are fortunate to also have a significant number of general dermatologists in the Western New York region.

Should you need additional options, we maintain excellent relationships with these offices and can refer you to trusted practitioners in your area who can provide comprehensive dermatological care.

Dr. Frederic Mohs

Mohs surgery is named in honor of the doctor who first developed the technique, Dr. Frederic Mohs. Dr. Mohs was a professor of surgery at the University of Wisconsin and developed the process in the 1930s.

It has since undergone additional improvements and has come to be known as “Mohs micrographic surgery” or simply “Mohs surgery”

Dr. Frederic Mohs

Mohs surgery is named in honor of the doctor who first developed the technique, Dr. Frederic Mohs. Dr Mohs was a professor of surgery at the University of Wisconsin and developed the process in the 1930’s. It has been since undergone additional improvements and has come to be known as “Mohs micrographic surgery” or simply “Mohs surgery”.

Your Visit

Many skin cancers we see are treated by a procedure known as Mohs micrographic surgery, or simply, Mohs surgery

Regardless, of the type of treatment you will undergo, it is best to come prepared

Mohs Micrographic Surgery

The visible tumor and a small segment of surrounding skin are removed.

The tissue is examined under a microscope to see if any cancer cells remain at any of the edges.

If any cancer remains, additional skin continues to be removedand examined under the microscope.

This process continues until no more cancer cells are found.

The visible tumor and a small segment of surrounding skin are removed.

The tissue is examined under a microscope to see if any cancer cells remain at any of the edges.

If any cancer remains, additional skin continues to be removed and examined under the microscope.

This process continues over and over again until no more cancer cells are found.

Mohs Micrographic Surgery

Types of Reconstruction

Frequently Asked Questions

Dr. Frederic Mohs

Dr. Frederic Mohs

The visible tumor and a small segment
of surrounding skin are removed.

The tissue is examined under a microscope
to see if any cancer cells remain at any of the edges.

If any cancer remains, additional skin continues to be removed
and examined under the microscope.