WHAT IS MOHS SURGERY?

Mohs 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 cancer. 

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 face.

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 cancerous "roots".

How is 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.

The 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 complete. 

If more 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.

How long 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 are required.

Will it 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.

What 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.

Will I 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 temporarily patched.