Regular Excision
Regular excision involves removing the tumor with a predetermined margin in one go and sending it to a separate lab for analysis. The lab will examine the tissue microscopically to ensure that all of the tumor was removed.
Mohs Surgery
Mohs surgery is a precise method of removing skin cancer. Your surgeon will remove all visible tumor and analyze it in our CLIA certified lab within the office to make sure that all the tumor was removed. We have a comfortable waiting room with drinks and snacks for our Mohs patients to relax in while the tissue is being examined. If there is residual tumor, your surgeon will do a second stage that same day, and repeat the process until all of the tumor is removed. This means that less healthy tissue is removed during Mohs surgery when compared with regular excision, and that you leave the office that day knowing that your cancer has been 100% removed.
MOHS MICROGRAPHIC SURGERY PATIENT INFORMATION
WHAT IS MOHS SURGERY?
Mohs surgery is a specialized, highly effective technique for removing skin cancers. It was developed in the 1930’s by Dr. Fredrick Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from 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 the 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 preservations of the maximum amount of normal skin is important.
WHY REMOVE SKIN CANCERS WITH MOHS SURGERY?
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:
1. 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.
2. 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.
3. Dr. Trimble then carefully examines these slides under the microscope. This allows examination of the entire surgical margin of the removed tissue. That is, the entire undersurface and the complete edge of the specimen are examined. All microscopic roots of the cancer can thus be precisely identified and pinpointed on the Mohs map.
If more cancer is found on the microscopic slides, Dr. Trimble 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. Trimble will discuss with you your options. These may include: 1) allowing the wound to heal naturally, without additional surgery; this sometimes produces the best cosmetic result, 2) wound repair by Dr. Trimble, 3) wound repair by the referring physician or making arrangements for wound repair, or 4) referral to another surgeon for wound closure.
WILL I HAVE PAIN, BRUISING, OR SWELLING AFTER SURGERY?
Most patients do not complain of significant pain. If there is discomfort, Tylenol is sometimes 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.
WILL MY INSURANCE COVER THE COST?
Most insurance policies cover the cost of Mohs surgery and the surgical reconstruction of the wound. Please check with your insurance carrier for exact information relating to your surgery. Dr. Trimble accepts Medicare assignment for cancer surgery.