What is Mohs Surgery?
Mohs surgery is a microscopically-guided procedure for skin cancer removal. It was developed more than 60 years ago by Dr. Frederic Mohs (pronounced “moze”). Since that time, the technique has been significantly advanced and refined. Today,Mohs surgery is widely accepted as the treatment with the highest cure rate for skin cancers in cosmetically sensitive areas and for certain other hard to treat skin cancers.
Who Performs Mohs Surgery?
Dr.Aerlyn Dawn is a fellowship-trained Mohs surgeon and a member of the prestigious Mohs College. He graduated magna cum laude from Harvard University and received his medical degree from the Duke University School of Medicine. Dr. Dawn completed a Dermatology residency at the University Pennsylvania in Philadelphia and a fellowship in Mohs surgeryand procedural dermatology. Dr. Dawn is a Diplomate of the American Board of Dermatology and has extensive experience in Mohs surgery for skin cancer and reconstructive surgery.
Dr. Dawn is assisted by a specialized team consisting of several surgical assistants, a technician who prepares the tissue for microscopic examination, and our office staff.
What are the Advantages of Mohs Surgery?
Though a skin cancer is usually visible to the naked eye, microscopic “roots” may extend more widely and deeply than the visible tumor. If these extensions of the tumor are not completely removed, the skin cancer may recur. To eliminate all of the microscopic tumor, most physicians must remove a wide area of normal skin around the visible skin cancer. Even with this safety margin, skin cancers removed with traditional treatments may frequently recur or require additional surgical procedures.
In contrast, Mohs surgery tracks the tumor-removal process microscopically. Therefore, Mohs surgery is better able to ensure that the entire skin cancer is removed,while also allowing us to remove as little normal, healthy skin as possible. This is particularly important in cosmetically sensitive areas. Like any surgical procedure, Mohs surgery will leave a scar, but preserving the maximum amount of healthy skin offers the best possible cosmetic result.
How Large Will the Wound Be?
The size and shape of the wound depends upon the extent of the skin cancer. Though this cannot be predicted before surgery, it is typically larger than the visible skin cancer.
How is Mohs Surgery Performed?
Mohs surgery is performed in our office on an outpatient basis. First, the site is marked and local anesthesia is used to numb the area. Then, Dr. Dawn removes a layer of skin, processesthe tissue in our laboratory, and examinesthe tissue under the microscope. If any cancer cells remain at the edges of the tissue, their locations are carefully diagrammed on a map. Using this map as a guide, Dr. Dawn removes another layer of skin. Depending on the branching pattern of the tumor, this process may need to be repeated several times.
How Will the Wound be Repaired?
In certain areas, wounds may look best if allowed to heal on their own. However, most defects require at least a few small stitches. Large or complicated wounds may need reconstruction with a skin flap or skin graft. Both techniques involve moving healthy skin to cover the surgical wound. Unusually large or complicated wounds may, however, require consultation with another subspecialist physician.
The type of repair needed for your wound cannot be determined until the entire skin cancer is removed. Remember that the first goal of Mohs surgery is to completely remove the skin cancer. Once
this isaccomplished, Dr. Dawn and our staff will help you to achieve the best cosmetic outcome possible.
How Long Will it Take?
Each stage of Mohs surgery takes only about 15 to 20 minutes; however, an additional 1 to 2 hoursmay be needed to process and evaluate yourtissue in our laboratory.
Depending on the extent of your skin cancer, this cycle may need to be repeated several times throughout the day until your tumor is entirely
removed.
In most cases, Dr. Dawn will repair your wound on the same day as your Mohs surgery. Depending on the complexity of the reconstruction, this may take between 20 minutes and 1 hour.
Because we cannot predict the size of your skin cancer before surgery, it is impossible to determine how long the process may take. Please plan to spend the entire day with us. We will try to keep your day as short as possible.
Will I Need to Come Back?
For uncomplicated wounds, only one return visit may be needed to remove stitches or examine the healing surgical site. For large wounds or complicated reconstructions, several follow up visits may be required. After surgery, it is essential that you return to your referring physician for routine skin examinations.
What are the Risks of Mohs Surgery?
*Scarring: All surgery results in a scar. Mohs surgery should, however, result in the smallest possible scar. In most cases, scars are initially pink and bumpy and then gradually fade over time. Occasionally, minor procedures are used to improve the final scar appearance.
*Bleeding: Though more extensive bleeding is possible, minor bleeding after surgery is not uncommon and is usually easily controlled.
*Pain: During surgery, pain is limited to the initial needles used for local anesthesia. Following surgery, most patients experience minor discomfort which can be controlled by Tylenol.
*Infection: Infection following surgery is possible but uncommon. If an area does become infected, it can usually be treated with oral antibiotics.
*Nerve Damage: Numbness or tingling around the surgical site is common and usually gradually resolves over time. Occasionally, your skin cancer may be located near a larger sensory nerve or a nerve that connects to a muscle. If such a nerve is damaged, permanent numbness or impaired muscle movement is possible.
*Recurrence: Mohs surgery offers the highest cure rate of all skin cancer treatments (98% to 99% for most tumors). However, no treatment can guarantee that the tumor will not grow back. Rarely, a tumor may reappear within the treated area.
How Should I Prepare for Surgery?
*Medicines: Continue to take all medications as prescribed by your physician. Be sure to take all of your medications on the morning of surgery, and bring any doses that you take during the day with you to our office.
*Alcohol: Alcohol increasesthe risk of bleeding. Please avoid alcohol for one day prior to surgery and two days after surgery.
*Transportation: We suggest that you have a companion drive you to and from our office. You may also be more comfortable with someone to keep you company in the waiting room.
*Meals: On the day of surgery, eat your normal breakfast. We suggest that you bring lunch withyou.
We look forward to making sure your experience with Mohs surgery is a positive one and appreciate the opportunity to serve you. Please let us know if you have any questions.
Aerlyn Dawn, M.D.
Fellowship-trained Mohs Surgeon
Diplomate, American Board of Dermatology
323 S. Union Avenue
Havre de Grace, MD 21078
Tel: (410) 939-0961
Fax: (410) 939-7832
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Mohs
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Offering the most
advanced method
for removing
skin cancers