WHAT IS MOHS SURGERY?
Mohs surgery has been around for over 70 years. Over 20 years of clinical studies have proven Mohs to offer the highest cure rate for the treatment of skin cancers. This state of the art treatment should be performed by a highly trained Mohs surgeon who acts as the surgeon, the pathologist and the reconstructive surgeon (plastic surgery). Mohs surgery not only provides a highest cure rate for the treatment of skin cancer, it also spares the most amount of healthy tissue surrounding the tumor. This allows for high cure rates (99% for most skin cancers) combined with optimal cosmetic outcome. This procedure is most often used for treating the two most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma. However, almost all other skin cancers are also best treated by Mohs surgery. On your day of surgery, you will benefit from having your cancer cured with the highest degree of certainty as well as obtain optimal repair by plastic surgery performed all in the same visit by Dr Allen.
To learn more about the details of this procedure please visit the American College of Mohs surgery website. www.mohscollege.org
HOW DO I CHOOSE MY MOHS SURGEON?
Mohs surgeons begin their training as dermatologists. At the end of residency training, there is a 1 to 2 year fellowship available for those interested in becoming highly trained experts, (fellowship-trained) Mohs surgeons. You should consider whether it is important to you that your surgeon has been highly trained in one of these internationally recognized fellowships. Fellowships were started in the 1980s and are regulated by the American College of Mohs surgery (ACMS). This regulating body ensures the highest standards of physician training. Only the American College of Mohs Surgery members are required to have this extensive training. The training includes performing over 500 Mohs surgery cases per year combined with complex reconstruction (plastic surgery) of the wounds. (Dr Allen has performed over 3000 Mohs cases in his training). In addition, some select fellowships (such as Dr Allen's) include extensive training in cosmetic surgery such as facelifts, liposuction, laser procedures, Botox®, soft tissue fillers, chemical peels, and other advanced cosmetic procedures.
DR ALLEN'S TRAINING BACKGROUND
After his dermatology training, Dr. Allen was awarded a position in a highly sought after fellowship in Mohs Surgery and Cosmetic Dermatology. He received his dermatology and fellowship training at Washington University in St. Louis, one of the leading training sites in the country for dermatology, Mohs surgery and cosmetic dermatology. He is a member of the American College of Mohs Surgery and has performed thousands of Mohs surgery cases with complex reconstruction (plastic surgery). He is also highly trained in performing cosmetic procedures. Dr. Allen is recognized as a leading expert in this field as evidenced by his television interviews, textbook publications, speaking invitations as well as expert interviews in leading magazines and TV (see about us page).
WHAT CAN I EXPECT FROM MY MOHS SURGERY CONSULTATION VISIT?
During your Mohs surgery consultation appointment the procedure will be explained to you in detail including the risks and benefits of Mohs surgery as well as alternative treatment options available. At this time, the physician will also obtain vital information regarding any special medical conditions that you may have. Once you have been screened and the cancer site evaluated you may then be scheduled for surgery.
THE MOHS PROCEDURE
A local numbing medicine will be injected into the area of the cancer (similar to the biopsy procedure). A very small layer of skin surrounding the tumor will be removed and processed immediately in the on-site laboratory. Dr. Allen will read these slides personally and determine whether there is any tumor remaining. This process usually takes approximately 30 minutes. (You will be in the operating room for 10 minutes or so to remove the first layer of tissue and it may take another 20 minutes to have the tissue processed and analyzed.) You will return to the waiting area with a bandage while you wait for the slide results. Once the tumor is completely removed, Dr. Allen will review your reconstruction (plastic surgery) options and then repair with the wound with optimal cosmetic results as the primary goal. Keep in mind, your local anesthesia should still be effective (lasts 1-2 hours) after your first layer and the stitching process should be relatively painless. Another advantage of Mohs surgery is that if the cancer is not deep it may be removed and allowed to heal without the need for stitches. This will be determined after the cancer is cured.
THE STITCHING PROCEDURE (PLASTIC SURGERY)
This often lasts approximately 30 minutes and is performed immediately (in the same day). Although your entire Mohs surgery and stitching may sometimes be completed within a one hour time period, we do ask that you allow for several hours with us so that there is enough time for your cancer to be adequately treated. In general, this will be somewhat of a "boring day" for you and we ask that you bring work or something to read while you are waiting for the slide results. We also provide beverages, coffee and healthy snacks for your convenience while you wait, but you're welcome to bring any food items with you.
DO I NEED TO BRING SOMEONE WITH ME? WILL I NEED A DRIVER?
In general, you do not need to bring someone with you and will not need a driver to take you home as the surgery is performed with local numbing medicine only, you will not be sedated nor will general anesthesia be administered (i.e. you are awake the entire time). However, we do welcome you to bring a significant other with you to keep you company while you wait for your slide results, etc. The only time that we require you to bring someone with you (a driver) is if your cancer is near your eyes as this area will be bandaged and it may be difficult to wear any driving glasses for the next several days.
DO I NEED TO STOP MY MEDICATIONS PRIOR TO MY SURGERY?
Almost never!! Dr. Allen almost never asks you to stop any of your prescribed medications for this type of surgery. The exception is if you are taking any elective (non-physician prescribed) blood thinners such as herbals, ibuprofen, Motrin, aspirin, baby aspirin, multivitamin and vitamin E. This is Important... If your doctor has prescribed aspirin or other blood thinners to you please DO NOT stop these medications but please do let Dr Allen know that you are taking these medications prior to your surgery.
WHAT WILL I NEED TO DO AFTER THE SURGERY?
Wound care is very easy and straight forward. The area should be kept covered with Vaseline ointment (plain petroleum jelly) and a bandage. On the day of surgery, we will apply a pressure bandage to be left in place for 48 hours. After 48 hours, once a day care should include cleaning the area gently with soap and water then again covering the site with Vaseline and a Band-Aid (or non-stick pad such as Telfa) until the stitches are removed (1 week) or until the wound is fully healed (medical studies have shown Vaseline to have the same low infection rate as antibiotic ointments without the risk of allergic reaction that occurs with products such as Neosporin® /Polysporin® /triple antibiotics, bacitracin).
WHEN WILL STITCHES BE REMOVED/ WHAT FOLLOW-UP APPOINTMENTS WILL I NEED?
Stitches on the face and neck will be removed within one week (5-7 days) following surgery. Stitches on the scalp and body will be removed within two weeks (8-10 days)following surgery. For wounds that did not require stitches we will usually see you back in the clinic within two weeks to perform a wound check in order to be sure the area is healing appropriately. We like to see all of our patients approximately 6 to 8 weeks after the surgery date to confirm that the area has healed well and that you have an excellent cosmetic outcome. After that, you can return to the care of your referring physician or general dermatologist.
WILL I HAVE A SCAR?
It is not possible to surgically remove a cancer and leave no scar at all. The advantage of Mohs surgery is that very small layers of skin are removed which results in the smallest scar possible (sparing healthy tissue) combined with the highest cure rates. Dr. Allen has extensive training in surgical reconstruction of these wounds and is able to minimize your scarring from this procedure. Please feel free to ask to see examples of his surgical outcomes (also available in the "photo gallery" section). Once the cancer is cured, we immediately turn our focus entirely on minimizing your scar and optimizing your cosmetic outcome.
WHAT OTHER OPTIONS DO I HAVE TO TREAT MY SKIN CANCER?
Different types of cancers can be treated by many different techniques. Not all skin cancers require Mohs surgery. However, long-term studies have clearly shown that Mohs surgery has the highest cure rate for the management of most types of skin cancers. Other surgical techniques to remove skin cancer examine less than 1% of the surgical margins to determine whether cancer is present. By contrast, Mohs surgery examines 100% of the surgical margins to determine if cancer is present. This is what allows for such a high cure rate with this technique and makes this technique far superior to all other forms of treating cancer. If you have been referred to Dr. Allen, it is likely that your physician has already determined that Mohs surgery is the best option in the management of your skin cancer. However, during your consultation with Dr. Allen, your diagnosis and other forms of treatments will be reviewed with you prior to any final decision to proceed with Mohs surgery. If you have not seen a doctor and you think you have a cancer, Dr Allen will confirm the diagnosis by a small skin biopsy and create a treatment plan accordingly.
WHO IS NOT A CANDIDATE FOR MOHS SURGERY?
In general, everyone is a candidate for Mohs surgery. Because of the very high cure rate and optimal cosmetic outcome Mohs surgery is the ideal treatment for skin cancer. In addition, because it is performed under local anesthesia and patients are not subject to general anesthesia (put to sleep) the risks of surgery are minimized.
Please note that for certain difficult tumors the process of Mohs surgery can take several hours. For the very large tumors, or cancers that have been previously treated by other techniques and have now returned, Mohs surgery is the most effective cure for these challenging tumors. Although, Mohs surgery clearly is best recommended for these large or recurrent tumors, some patients may elect for surgical techniques with lower cure rates but can sometimes be performed in less time. Each and every patient is different and each and every cancer is different; therefore, prior to making a final decision regarding skin cancer surgery it is recommended that you have a consultation with a skin cancer specialist, such as Dr. Allen, so that you may learn of all your options, the advantages and disadvantages of each technique, and then make the best informed decision for your care.
