What is Mohs Micrographic Surgery?
Mohs micrographic surgery is the most effective technique for the treatment of skin cancer, with a success rate of up to 99%. It is a precise, skin-sparing technique that allows for the creation of the smallest possible surgical wound while also achieving the highest possible cure rate. The procedure was developed in the 1930s by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that the tissue that gets cut out is checked for residual cancer right after removal, while you wait in clinic, and more tissue is removed as needed until all the cancer is confirmed to be gone. Mohs surgery is currently the gold standard for treatment of skin cancers in cosmetically sensitive areas (e.g. head, neck, hands, feet, genitalia), and for skin cancers that recurred after previous treatment. Mohs surgery can also be used in other situations and these can be discussed with your dermatologist. It is important to note that Mohs surgery must meet indication criteria for insurance coverage. This is determined by various factors including, but not limited to, the type of skin cancer and location on the body.
It is important to note that Mohs surgery is not appropriate for the treatment of all skin cancers and must meet indication criteria for insurance coverage. Mohs surgery is indicated for skin cancers located in areas such as the nose, ears, eyelids, lips, hairline, hands, feet, and genitals, in which maximal preservation of healthy tissue is critical for cosmetic or functional purposes. Mohs micrographic surgery can also be used to treat skin cancers that have recurred following previous treatment or for cancers that are at high risk for recurrence.
In other areas such as the arms or thighs where a meticulous approach to preserve every millimeter of healthy tissue is not necessary, the most reasonable approach is often excision. Compared with Mohs surgery, excisions save a patient time. If a sufficient margin of healthy-appearing tissue is removed, then the cure rate is comparable as well.
Meet our Mohs surgeon
Dr. Jack Lee is a board-certified dermatologist and ACGME fellowship-trained Mohs surgeon who enjoys caring for patients of all ages, with a focus in procedural dermatology. He specializes in Mohs surgery for cutaneous malignancies, advanced reconstruction of surgical defects, cutaneous oncology, excision of benign neoplasms, surgery for hidradenitis suppurativa, and nail procedures.
Dr. Lee graduated magna cum laude from Brown University in Providence, RI and earned his medical degree at the University of Virginia in Charlottesville, VA, where he was inducted into the Alpha Omega Alpha honor society.
He completed his internship in internal medicine at the Beth Israel Deaconess Harvard teaching hospital in Boston, MA, followed by his dermatology residency at the University of Virginia.
During his residency he authored numerous peer-reviewed scientific articles, became chief resident, and was active in a national performance and quality improvement committee with the American Academy of Dermatology. He subsequently completed his fellowship in Mohs Micrographic Surgery and Dermatologic Oncology at the University of Virginia. He is a member of the American Academy of Dermatology and the American College of Mohs Surgery. During his free time, Dr. Lee enjoys movies, TV shows, web surfing, calisthenics, high-intensity interval training, and dabbling in nutritional science.
- American College of Mohs Surgery – www.mohscollege.org
- The Skin Cancer Foundation – www.skincancer.org
Advantages of the Mohs Surgical Procedure
Skin cancers can be deceptively large – with extensive microscopic “roots” underneath the skin that are invisible to the naked eye. In the past, a large amount of normal skin surrounding the cancer site would be removed in order to ensure a reasonable chance of getting all the cancer. Mohs surgery was invented so that a much smaller amount of normal-looking skin can be removed to start with, checked for any residual cancer right then and there on the same day, and any additional skin can then be removed only as needed. This generally resulted in smaller surgical wounds and higher cure rates, the best of both worlds. Mohs surgery is currently the gold standard for treatment of skin cancers in cosmetically sensitive areas of the body and for skin cancers that recurred after previous treatment attempt(s). Mohs surgery can also be used in other situations and these can be discussed with your dermatologist. It is important to note that Mohs surgery must meet indication criteria for insurance coverage.
American College of Mohs Surgery: Patient Information Before and After Mohs Surgery
(click the link to see an educational pamphlet.)
FAQs Before Surgery
Do I need to fast before surgery? Are there any dietary restrictions? Can I drink alcohol?
No. We recommend that you eat breakfast and take all of your normal medications. There are no dietary restrictions but we suggest that you refrain from drinking alcohol for 2 days before and after your surgery. Alcohol thins the blood and increases your bleeding risk.
What anesthesia do the doctors use? Will I be sedated?
The doctors use local anesthesia only. You will not be sedated during the procedure. In most cases, the anesthesia is exactly the same as the biopsy.
How long will the surgery last? How long will I be there?
Mohs surgery occurs in stages which include removal of tissue, preparation of tissue, and examination of tissue. This may need to be done multiple times to clear a skin cancer, after which a repair is then done. Accordingly, many patients are in our office for several hours before their procedure is completed. We ask that you prepare to potentially be in the office all day.
Is there wifi and can I bring a cell phone?
Yes! Cell phones do not interfere with our surgical equipment and can be used while you wait between stages. We have complimentary WiFi and you are welcome to bring your laptop.
Can I drive?
This depends mostly on the site of your surgery. You will not be sedated so mentally you will be able to drive. However, if the site is near your eye (including upper cheek and nose) the postoperative bandage may obstruct your vision especially if you wear glasses. Other examples include a surgery on the neck which may make it difficult to turn your head while backing up a car, or a surgery on the foot which may prohibit you from operating the vehicle. Some individuals who are anxious about their procedure may feel more relaxed if they have someone else drive them.
If you have any questions, please ask us when you schedule your appointment.
FAQs After Surgery
What will I look like when I leave the office? How will I feel when I leave the office?
When you leave the office there will be a large bulky pressure bandage in place to prevent bleeding. The area will be numb from the local anesthesia for about a couple hours after surgery. After the numbness wears off, the amount of discomfort will vary, but over-the-counter pain medications are usually more than adequate to manage the discomfort (see below for “What pain medicines can I take?”). Most people feel a little tired after the procedure as it can be a long day. After surgery, go home, relax, and take it easy!
Can I exercise?
The safest bet is to not exercise for 14 days after your surgery. This is recommended in order to both minimize stretching of the wound and also to prevent bleeding. Stretching of the wound can lead to the stitches breaking and the wound opening back up. Bleeding can also occur when your blood pressure and heart rate increase with exercise. Normal daily activities such as walking or driving are fine, but any strenuous exercise after surgery is discouraged for 14 days. If you have specific questions, ask your physician.
Do I have to keep the wound covered?
The #1 most important thing in post op wound care is to keep the wound GREASY with plain petroleum jelly ointment (e.g. Vaseline) so that the wound does not “dry out” and form a scab. Keeping the wound covered will help prevent the ointment from rubbing away.
What pain medicines can I take?
Over-the-counter pain medications are generally more than adequate including ibuprofen and tylenol, but your physician will advise you after the procedure what post-treatment pain management option is best based on your procedure and personal medical conditions.
Insurance Coverage for Mohs Surgery
Most insurance policies cover the costs of Mohs surgery and the reconstruction of the resultant surgical defect. Please contact the billing department 609-799-1600 or 267-789-2110 of your Mohs surgeon’s office if you have questions about insurance coverage or to see if your insurer requires you to have a referral from your primary care physician. You may need to contact your insurance company directly about benefits or coverage.
