Frederic E. Mohs, M.D. (1910–2002)
Professor Emeritus of Surgery,
University of Wisconsin
Mohs Skin Cancer Surgery
Superior Training, Superior Results
What is Mohs Surgery?
Mohs micrographic surgery is an outpatient skin cancer surgery procedure that provides the highest cure rate for basal cell and squamous cell carcinomas (98-99% cure rates), as well as the highest cure rate for locally recurrent skin cancers. The procedure was developed by Dr. Frederick Mohs at the University of Wisconsin in the 1930’s and is now used throughout the world.
Mohs surgery is unique because it allows the Mohs surgeon to precisely remove skin cancers without removing large amounts of normal skin. It is the procedure of choice for recurrent cancers, large cancers, and cancers in cosmetically sensitive areas such as the nose, face, eyelids, lips, and ears. It offers the best chance that your cancer is completely removed, while sparing the maximum amount of normal skin as possible. The entire procedure is done safely under local anesthesia in the office, avoiding the need for general anesthesia. For more information about Mohs micrographic surgery visit www.mohscollege.org
Our Doctors are ACMS Members
Dr. Douglas Fife and Dr. Mac Machan are two of only a few Mohs micrographic surgeons in the Las Vegas area who are eligible for membership in the American College of Mohs Surgery (ACMS). All members of the ACMS were required to complete a one-year fellowship in Mohs micrographic surgery after Dermatology Residency, in which they received intensive training in surgical removal and reconstruction of difficult skin cancers on the face.
We are also currently the only center in Las Vegas performing Mohs surgery for Melanoma with same-day immunostaining in order to achieve the highest possible local cure rate. We are routinely performing MART-1 immunostains for both invasive melanoma and melanoma in-situ. The combination of Mohs surgery with immunostaining can provide a great benefit to patients who receive same-day histologic confirmation of tumor clearance and reconstruction during the same visit.
FREQUENTLY ASKED QUESTIONS
The thought of undergoing surgery for skin cancer produces anxiety in many patients. One of the main goals of Surgical Dermatology & Laser Center is to provide the best care and maximum comfort to our patients. We do that by educating our clients about the entire procedure and our vast experience in the same type of skin cancer surgery, so that the patient understands fully that they are in good hands. In order to help you understand the process of Mohs surgery and prepare for your day, please read the information below. In addition, you can visit our testimonials page to read about the experiences of other patients.
Should I stop taking my medications ordered by one of my doctors?
No. Continue all medications which have been prescribed by one of your doctors, including blood thinners (Aspirin, Coumadin [warfarin], or Plavix [clopidogrel]). Please bring with you a complete list of your medications on the day of your surgery.
If you take coumadin, please have a routine coagulation study (PT/INR) drawn within 1 week of your surgery day. Have the results faxed to Surgical Dermatology & Laser Center (702) 933-1444.
Should I stop over the counter medicines, vitamins, or herbal supplements which have NOT been ordered by my doctor?
Yes. To prevent bleeding problems, please discontinue the following medications and supplements unless ordered by your doctor, starting 7-10 days prior to surgery: Vitamin E, fish oil, gingko biloba and all other herbal supplements.
How long will my surgery day last?
The length of Mohs surgery is unpredictable because some skin cancers grow underneath the skin more than at the surface. There are multiple brief episodes of surgery followed by long periods of waiting while the tissue is processed and evaluated under the microscope. Usually the day lasts 3-5 hours, but occasionally can last all day. You may want to bring reading material, food for lunch or snacks, or a friend/loved one to help you pass the time.
Will there be much pain during or after the surgery?
Injections of local anesthesia will control the pain during surgery. Normally patients experience only mild pain after surgery, which is usually controlled by Tylenol. In some cases, our providers will prescribe a stronger pain medication.
How should I take care of the wound after surgery?
Our staff will demonstrate how to care for your wound and will give you written instructions and your provider’s direct contact information in case of a rare emergency. Usually you will return to have your sutures removed in 1-2 weeks.
When can I resume normal activities after surgery?
We recommend that you avoid strenuous activities for at least a week after your surgery. Be aware that you may have significant swelling, redness, or bruising for one or two weeks, especially if your cancer is on the central face (forehead, eyes, nose, lips).
Is there anything else I should do to prepare for my surgery?
Eat a light breakfast or lunch before your surgery. Arrange for someone to drive you home from surgery in case your postoperative bandage covers your eyes or if sedative medications are required. Also, if your dentist routinely prescribes antibiotics prior to dental procedures please inform us of your specific condition.
YOUR MOHS SURGERY DAY
Please arrive 15 minutes early prior to your appointment time to check in (or 30 minutes if it is your first time visiting the office in order to complete paperwork). You will be escorted to a surgery room by nursing staff, who will briefly review your medical history and cleanse the surgical area.
One of our providers will then meet you, explain the procedure, and answer any questions. The visible skin cancer will be circled with a marking pen and a local anesthetic will be injected. The cancer and a very small amount of surrounding skin will be removed with a scalpel. Any bleeding will be stopped by cautery or pressure, and a temporary dressing will be placed by the nursing staff, who will then escort you to a waiting area.
The specimen is carefully oriented, marked with colored dye. A technician takes the tissue, freezes it, cuts it in thin slices, places it on slides, and stains it for microscopic evaluation. Dr. Fife or Dr. Machan then carefully examines the slides under the microscope, checking the edges of each piece of skin for residual skin cancer. The entire process of processing the tissue and reading the slide usually takes around 1 hour.
If any tumor is still present at the edges, you are brought back to the surgery room and a second stage of surgery is performed to remove the cancer only in the specific area where it still remains. This process continues until all of the cancer has been removed. Usually 1-3 stages of Mohs are required to clear a tumor, but occasionally more stages are required (up to 7-8). The entire surgery day may last from a few hours to the entire day.
When all of the cancer has been removed, your doctor will discuss all the options for repairing your wound, which either performed the same day or is postponed to a later date. Options for wound repair include:
- Simple side-to-side repair (also called primary closure or linear repair)
- Skin flap (a local flap of skin is brought in from the side of the wound to fill it in)
- Skin graft (skin is harvested from another site and placed to cover the wound)
- Occasionally allowing the wound to heal on its own provides the best appearance