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Mohs Micrographic Surgery

What is Mohs surgery?

Moh’s micrographic surgery is performed by a specially trained dermatologist under local anesthesia. The treatment involves the progressive excision of the cancer using serial frozen section analysis and precise mapping of the excised tissue until no evidence of remaining tumor exists. Moh’s surgery is recommended by Dr. Parker in the following circumstances: for difficult and high-risk basal and squamous cell carcinomas including tumors greater than 2 cm in diameter, located in areas where deep invasion is more likely, rapidly-growing, recurrent or ill-defined tumors, and those located in an area of previous radiation or where perineural invasion is likely.

Coordinated reconstruction of the patient undergoing Moh’s surgery is performed by Dr. Parker later that same day or the following day. The resultant size and extent of the soft tissue defect determines the type of reconstruction to be done. Some defects are best repaired with a skin graft (skin removed and transferred from a distant area); others are better suited for a skin flap (the sliding of adjacent skin into the defect). In either case, Dr. Parker utilizes techniques borrowed from his cosmetic surgeries to make the resultant scarring as inconspicuous as possible.

Do I Need Mohs Surgery?

Mohs surgery is a highly successful treatment option for the right candidates. Consulting with an experienced dermatologist or board certified plastic surgeon can help you determine if Mohs is an appropriate procedure for you.

Mohs surgery is used to remove a variety of malignant lesions, with the two most common being squamous and basal cell carcinomas. Depending on the type of lesion, where it’s located, and your doctor’s recommendation, Mohs or surgical excision with frozen section margin control may be suggested for treating skin cancer.

Mohs can treat the following malignant lesions:

If you are unsure whether you have a malignant lesion or suspect you may have skin cancer, contact your physician immediately.

Will Mohs leave a large scar?

The goal of Mohs micrographic surgery is to preserve as much healthy skin as possible and ensure all cancerous tissue is removed, all while retaining options for reconstructive surgery. Because Mohs surgery is progressive, the extent of tissue removal—and resultant scarring—cannot be fully anticipated. Coordinated reconstruction by a board certified plastic surgeon is recommended for patients undergoing Mohs surgery with a dermatologist.

Dr. Parker often receives referrals for post-Mohs reconstruction. Coordinated reconstructive surgery is performed by Dr. Parker either soon after the Mohs surgery or on the following day. The extent and type of reconstruction to be done is determined by the resulting size and degree of soft tissue defect after the Mohs procedure.

The potential for visible scarring is present with all surgical procedures, as many factors contribute to the appearance of surgical scars, including the size and location of the defect and unique skin characteristics. Modified Mohs surgery spares more tissue than traditional skin cancer surgery for less noticeable scarring.

Dr. Parker’s extensive experience with cosmetic techniques helps him to make any resulting scars inconspicuous as possible. Using skin grafting or skin flap techniques, Dr. Parker incorporates suture lines into natural folds and skin lines wherever possible.

Post-surgical scarring improves with time as the surgical site heals, sometimes taking up to a year to fully “settle.” It is important to follow instructions and be patient during the healing process. Stay in communication with your doctors if you have any concerns.