Micrographic surgery is a specialized, highly
effective technique for removing skin cancers. It was
developed in the 1930's by Dr. Frederic Mohs at the
University of Wisconsin and is now practiced
throughout the world. Mohs surgery differs from the
other skin cancer treatments in that it permits the
immediate and complete microscopic examination of the
removed cancer tissue so that all roots and extensions
of the cancer can be eliminated. Mohs surgery has the
highest reported cure rate of all treatments for skin
Treating all skin cancers with Mohs surgery is not
necessary. Mohs surgery is reserved for skin cancers
that grow back after previous treatment, cancers that
are at high risk of recurring, or cancers that are
located in cosmetic areas where preservation of the
maximum amount of normal skin is important, like the
Physicians who have the training, surgical and
laboratory facilities, and staff to perform this
specialized technique practice Mohs surgery. Dr. Gaul
received training in Mohs surgery with Dr. Frederic
Mohs at the University of Wisconsin and has used Mohs
surgery to treat thousands of skin cancer patients. He
is a Fellow of American Society for Mohs Micrographic
Surgery, American Society for Dermatologic Surgery and
the American Academy of Dermatology. He is Recipient
of AMA CMC award and AAD CME Award. He was board
certified by the American Board of Dermatology
Why remove skin cancers with Mohs Surgery?
in 1986 and Recertified by the American Board of
Dermatology, in Dermatologic Surgery and General
Dermatology in 2001, specializing in Mohs Micrographic
surgery and reconstructive surgery for skin cancer.
Some skin cancers are deceptively large---far bigger
under the skin than they appear to be from the
surface. These cancers may have "roots" in the skin or
along blood vessels, nerves, or cartilage. Also, skin
cancers that recur after previous treatments may send
out extensions deep under the scar tissue that has
formed. Mohs surgery is specifically designed to
remove these cancers by tracking and removing these
Mohs Surgery Done?
There are three steps involved in Mohs surgery:
The skin is made completely numb using a local
anesthetic. The visible cancer is removed with a thin
layer of additional tissue. This takes only a few
minutes and the patient may then return to the waiting
room. A detailed diagram (a Mohs map) of the removed
specimen is drawn.
specimen is color coded to distinguish top from bottom
and left from right. A technician freezes the tissue
and removes very thin slices from the entire edge and
undersurface. These slices are placed on microscope
slides and stained for examination under the
microscope. This is the most time consuming part of
the procedure, often requiring an hour or more to
cancer is found on the microscopic slides, Dr. Gaul
uses the Mohs map to remove additional tissue only
where cancer is present. This allows the Mohs surgery
technique to leave the smallest possible surgical
defect because no guess work is involved in deciding
where to remove additional tissue. Only tissue around
the "roots" and extensions of cancer is removed.
does it take?
Most cases can be completed in three or fewer stages,
requiring less than four hours. However, no one can
predict how extensive a cancer will be because the
size of a skin cancer's "roots" cannot be estimated in
advance. We therefore ask that you reserve the entire
day for surgery, in case additional surgical sessions
leave a scar?
Yes. Any form of surgery leaves a scar. Mohs surgery,
however, will leave one of the smallest possible
surgical defects, and therefore a smaller final scar.
happens after the Mohs surgery is completed?
When the cancer is removed, Dr. Gaul will discuss with
you your options. These may include: 1. Allowing the
wound to heal naturally, without additional surgery
(often produces the best cosmetic result) 2. Wound
repair by Dr. Gaul.
have pain, bruising, or swelling after surgery?
Most patients do not complain of significant pain. If
there is discomfort, Tylenol is usually all that is
necessary for relief. However, stronger pain
medications will be prescribed when needed. You may
have some bruising and swelling around the wound,
especially if surgery is being done close to the eyes.
How do I
prepare for surgery?
Get a good night's rest and eat normally the day of
surgery. If you are taking prescription medications,
continue to take them unless otherwise directed.
However, avoid taking medications that contain
Aspirin, baby aspirin, alka seltzer, Bufferin, Vitamin
E, Ginseng, Ginkobiloba, garlic, ginger and feverfew
for 10 days before your surgery. Also please do not
take any Aspirin substitutes, such as Advil, Motrin,
Aleve, Nuprin, Ibuprofen, Nalfon, Naprosyn, etc within
5 days of surgery. You may, however take Tylenol at
any time before surgery. Do NOT stop Coumadin or Plavix. You may want to bring a book, magazine,
crossword puzzle or friend with you to occupy your
time while waiting for your slides to be processed and
examined. Beepers are available if you wish to leave
the clinic while we do the lab work. You may bring a
snack or sack lunch if you do not wish to eat out.
Arrange for someone to drive you home if the area
being treated is near your eye, since this area may be