Video Production by Josh Melendez

This video contains an overview and procedure of a Mohs Micrographic surgery.

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Here are some great resources:

An app that the University of Michigan that allows you to take photos of your moles and set reminders for self body exams. It’s called UMSkinCheck and is only available for Apple products.

These links have further information on Mohs surgery and are great resources:

Video Transcript:

Okay, so you’ve been diagnosed with a non-melanoma skin cancer, and that’s either a basal cell cancer, or squamous cell cancer for the vast majority of cases. And you’ve been recommended to have Mohs Micrographic Surgery.

Now Mohs Micrographic Surgery was named after a gentleman Frederic Mohs, who invented the procedure to get the highest cure rates possible, and Mohs gets those cure rates. It’s somewhere between 97 and 99 percent. And this procedure also keeps the hole as small as possible. And that’s important because there are some areas of the body that are just hard to close, like your anterior shin. Or there are other areas of the body of high cosmetic importance, that we need to keep the hole as small as possible, so that theoretically, we can give you the best cosmetic result possible.

Now in order to achieve these results there is a drawback, and that drawback is that you are in the clinic for approximately three hours throughout the procedure. Now most of that time you’re bored, so please bring a book or something to read to keep you occupied, but fortunately you do not have to go under general anesthesia for the vast majority of cases. All that’s required is some local numbing, and then you usually go home the same day with minimal amount of pain, and with a 97 to 99 percent cure rate. It is a fantastic procedure, and we love performing it.

So what will happen is, you’ll come into the clinic. You’ll be brought back into the room. The doctor will identify the lesion, draw around the lesion, confirm the site with you. It will be locally numbed just like the biopsy, so a little poke and a little burn. And then we’ll take a small piece of tissue around what our eyes can see. Okay, so what we have here is a squamous cell cancer that’s been previously biopsied. I’m going to clean it with some alcohol. So you can see right here… that is about the area… Well, 1.2 centimeters, and I’m going to go just to the outside of this line, so that I can give a couple millimeters of margins, so I’m actually gonna be taking out 1.4.

If it’s clear, then we’re gonna close it with something that looks like this. That doesn’t look too bad too close. But if we were going to do this with a surgical approach, with an excision, we would need to take 5 millimeter margins, which would bring it out to about right here for both. And then that would result in a closure that is approximately something like this. Now the difference between closing that, and closing this on an area that’s tight, that is a big, big difference.

So Mohs allows us, Mohs Micrographic Surgery allows us to keep the hole as small as possible. Which theoretically means a smaller scar, and that theoretically means a better cosmetic outcome. And the clearance rate for a Mohs is somewhere between 97 and 99 percent. Clearance rate for an excision, if we were to just excise it, is some were around 90 percent. Now here comes the poke and the burn… Ouch, ouch… And we’re numbing this whole area… So again we’re gonna go to the outside this line… And then we’re going to mark the tissue that we’re removing as well as the skin. So we’re going to put a little mark there… A little mark here… A little mark here… And a little mark there.

And then when we take it to process, what we’re gonna do is we’re gonna dye all these with different dyes, so that if there’s just a little bit of cancer, here we can chase it that way. If there’s cancer in the whole thing, we’ll go around the whole area. I’m trying to get around the area as much as possible. Because the goal is to remove all the cancer. You will then have a bandage on the area, and then most likely go back out into the waiting room and wait for approximately 45 minutes to an hour. During that time, we’re processing the tissue in one of these machines and that’s why it takes that 45 minutes. Instead of sending it off to a laboratory and you wait for a week or two for the results, we do the results while you wait.

Now once the tissue is processed it goes back to the doctor and they look at it under the microscope. And we have a very good idea of the directionality of the cancer. If the cancer is gone, we bring you back into the room and we close you up with stitches, and those stitches are usually removed within 5 to 21 days. If there’s still more cancer to go after, we go after it based off of what the sample showed. And so it’s really at this point we can really hone in on the area we go to. This process continues until we have clear margins, and then we close you up and let you go home.

Okay, so we’ve removed the cancer and we have clear margins, so now we are sewing it up. So we’re just going to extend this down… Now this is a lower leg, and lower legs take a long time to heal. So we’re gonna leave the stitches in for probably 14 days. So the whole purpose of these videos is to educate you because an educated patient is the best patient. And oftentimes when you get a diagnosis from your doctor, it is quite confusing as to what the best treatment modality is, for your individual condition.

Now on the topic of non-melanoma skin cancers, the American Academy of Dermatology has come up with a fantastic and free app that you can use on your smartphone, to determine if the Mohs Micrographic Technique is right for you. So as you go through this app, you’re gonna see charts, you’re gonna see the diagnosis, you’re gonna see other pertinent information to determine if Mohs Micrographic Surgery is appropriate for your individual condition. Your dermatologist might be recommending Mohs for you, and then you go on the app and it says that it’s appropriate use. Then most likely that is the best treatment for you. Sometimes a dermatologist is going to recommend Mohs Micrographic Surgery and it doesn’t meet the appropriate use criteria for Mohs. And sometimes your dermatologist is going to recommend another treatment modality for your non-melanoma skin cancer, even though it does meet appropriate use criteria for Mohs.

In either case, all I ask you to do is have a conversation with your local dermatologist. Because I am sure they have good reasons for why they’re recommending the treatment that they are So again we encourage you to take control of your diagnosis of non-melanoma skin cancer, to become as educated as possible. To use the app so that you can determine if Mohs Micrographic Surgery is right for you, and then to have a discussion with your local dermatologist, so that you can get the care that you deserve.

Patient: The Mohs procedure I think has been a godsend, I don’t know how long it’s been around, but it certainly has helped me. The Mohs procedures that you’ve performed, I was very comfortable with. I knew what a Mohs procedure was, and I knew that it might be two or three attempts to clear the margins. But I also knew that when you were finished and said they were clear I could count on that. You’re able to determine the, the margins right away, or, within an hour, and that’s a big deal for the patient.

About the author

Dr. Anderson with Doctors Quarterly Magazine - Cropped
Dr. Reagan Anderson

Dr. Anderson is a Board Certified Dermatologist and Mohs Micrographic Surgeon. He serves as a Clinical Professor of Dermatology and is actively involved in patient and healthcare provider education on dermatology conditions and treatment.

Colorado Dermatology Institute
8580 Scarborough Drive / 1220 Lake Plaza Drive
Colorado Springs, Colorado