OVERVIEW
Originally developed in the 1930s by Dr. Frederic Mohs, Mohs micrographic surgery has been refined into the most advanced, precise, and effective treatment for an increasing variety of skin cancer types. It is considered by many to be the gold standard for skin cancer treatment. With this technique, a Mohs surgeon can precisely identify and remove an entire tumor while leaving the surrounding healthy tissue intact and unharmed. In this manner, Mohs surgery offers the best cosmetic outcome for the surgical treatment of skin cancer and the highest possible cure rates.

Mohs micrographic surgery involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached (called clear margins). Because of the manner in which the tissue is processed and examined under the microscope, Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%. As an ACMS-Mohs surgeon, Dr. Gharavi has performed over 15,000 skin cancer surgeries and is highly-trained in skin cancer surgery, pathology, and reconstructive surgery.

ADVANTAGES OF MOHS SURGERY

Mohs surgery is highly effective and unique because of the manner in which the removed tissue is microscopically processed and examined, allowing for evaluation of 100% of the surgical margins. The pathologic interpretation of the tissue margins is done on-site by the Mohs surgeon, who is specially trained in the reading of these slides and is best able to correlate any microscopic findings with the surgical site on the patient. Other skin cancer treatment methods blindly estimate the amount of tissue to treat, which can result in the unnecessary removal of healthy skin tissue. Furthermore, these other non-Mohs methods do not examine 100% of the surgical margin and may results in tumor re-growth if any cancer is missed.

The advantages of Mohs surgery include:

• Ensuring complete cancer removal, virtually eliminating the risk of recurrence
• Minimizing the amount of healthy tissue lost, resulting in minimal scarring
• Maximizing the functional and cosmetic outcome resulting from surgery
• Repairing the surgical site, often on the same day that the cancer is removed
• Curing skin cancer when other methods have failed

Mohs surgery is also highly cost effective. Because of its high cure rate, most patients require only a single surgery, including reconstruction of the wound as well. Other methods might require additional surgeries and pathology readings in order to repair the wound and to treat the cancer if it is not completely removed. Each of these additional surgeries and pathology readings require separate fees, while a single Mohs surgery procedure includes all of these into one fee. Furthermore, the psychological impact of being subjected to multiple procedures when cancer recurs can be significant. Mohs surgery minimizes the risk of recurrence, provides the highest possible cure rate and the more optimal cosmetic outcome.

BEFORE YOUR SURGERY
Prior to surgery, you may have a consultation with your Mohs surgeon to go over any questions or concerns that you may have. If you have already had Mohs surgery in the past, and are familiar with the procedure, you may elect to skip the consultation. Once you have set an appointment for surgery, you will receive a detailed list of instructions to follow beforehand.

You may be asked to:

• Temporarily stop the use of certain medications, including some over-the-counter pain relievers, supplements, and other medicines
• Stop consuming certain foods or beverages before your procedure
• Stop smoking
• Clear a half or full-day for your procedure, because it is difficult to predict how long it may take

Dr. Gharavi and his team will give you more information about these and other considerations before your surgery, and it’s important to follow this advice as closely as you can to ensure a successful outcome.

YOUR MOHS PROCEDURE
Mohs micrographic surgery is typically performed as an outpatient procedure in the office, which has an on-site surgical suite and a laboratory for microscopic examination of tissue. Typically, surgery starts early in the morning and is completed the same day, depending on the extent of the tumor and the amount of reconstruction necessary. Most patients are finished within 2-3 hours from the start of the procedure.

The procedure begins with Dr. Gharavi and his team marking and outlining the margin or border around your previous biopsy site. You will then receive local anesthesia around the area of the tumor, so you are awake during the entire procedure. The use of local anesthesia versus general anesthesia provides numerous benefits, including preventing a lengthy recovery and possible side effects from general anesthesia. We will ensure that you are completely numb in the area of the surgery, throughout the duration of the surgery, so that the procedure remains easy and comfortable for you.

After the area has been numbed, Dr. Gharavi will remove the visible tumor, along with a thin layer of surrounding tissue, using a sharp scalpel. The tissue will be sent to our Mohs laboratory. A technician then prepares this tissue and puts it on slides for Dr. Gharavi to examine under the microscope. If Dr. Gharavi sees evidence of cancer around the outer edges of the removed tissue, he will take another layer of tissue from the area where the cancer was detected. This ensures that only cancerous tissue is removed during the procedure, minimizing the loss of healthy tissue. Dr. Gharavi repeats these steps until all samples are free of cancer. Although there are always exceptions to the rule, most tumors require 1 to 3 stages for complete removal.

To get a better picture of how this process takes place, please view the following video and our guide, Mohs Step-by-Step Process.

AFTER YOUR SURGERY
When your surgery is complete, Dr. Gharavi will assess the wound and discuss your options for ideal functional and cosmetic reconstruction. As an ACMS surgeon, Dr. Gharavi understands that a good cosmetic result is an important part of the recovery process, and that’s why he works diligently and precisely to leave as little tissue damage as possible. If reconstruction is necessary, Dr. Gharavi usually repairs the area the same day as the tumor removal.