Introduction

Over 30 years ago, Dr. Frederic Mohs developed a technique for the microscopically controlled removal of problem skin cancers. Mohs surgery is done under local anesthesia and rarely requires hospitalization. The Mohs procedure is extremely precise demonstrated by the very high cure rate, (99% of first time skin cancers, and 95%-97% of skin cancers that have come back). The drawbacks are that it is somewhat time consuming and requires specialized training, personnel, and equipment, but it is well worth the trouble.

Note: Make sure your physician is Mohs fellowship trained. There are physicians out there that perform the procedure without the full year or two of fellowship training.

This page attempts to answer some of your questions you may have as a patient. We expect and welcome further questions about the surgery.

What is Skin Cancer?

Cancer is tissue that grows at an uncontrollable and unpredictable rate. The types that we most commonly treat with Mohs surgery are basal cell carcinoma and squamous cell carcinomas, along with some other very rare skin cancers. Skin cancer begins at the surface of the skin and grows roots downward. What can be seen of the cancer on the surface is usually only the "tip of the iceberg."

Is it Dangerous?

Skin cancers that we treat with Mohs surgery usually do not spread to other parts of the body and cause death. They can, and often do, destroy the skin and structures where they grow and locally spread. A skin cancer left untreated long enough can cause death if it invades into a vital structure. These skin cancers do not go away on their own! Though they may seem to heal over, if untreated, they always come back bigger, and with deeper roots. While the removal of skin cancer is not an emergency, in general they should be removed within a month or two of diagnosis.

What Causes Skin Cancer?

No one is certain of all the causes of skin cancer. Several factors, most importantly is sun exposure, seem to interact together to make some people more susceptible. People with very fair skin, light or red hair, and blue eyes definitely get skin cancer most often. Heredity does seem to play a part, with some families having more skin cancer than others. Other possible causes of skin cancer include X-ray therapy, given in the past for acne, old burn scars, and certain patient medicines such as Fowler's solution and Paris Green insecticide, both of which contain arsenic.

Will My Insurance Pay For Mohs Surgery?

Yes, almost always. Mohs surgery is time consuming and labor intensive. You are responsible for any deductible and 20% copayment if required, although if you have a secondary policy it is almost always covered. We like to arrange for your insurance company to reimburse us directly if possible. If this is a hardship, let us know, and we will work out an alternative plan. If you are a Medicare enrollee, be sure to mention any special supplemental policies to the front desk secretaries. Also, bring any insurance cards and policy numbers with you.

How May Skin Cancer Be Treated?

There are a variety of successful methods of treating most skin cancers in most people. These include scraping and burning, cutting out and sewing up, x-ray treatment, and cryosurgery (freezing). Mohs skin cancer surgery has a superior cure rate, and often times is performed after a prior treatment has failed. It is important to emphasize however, that no method at any time, including the Mohs technique, can promise 100% cure rates.

The Process:

	The roots of a skin cancer may extend beyond the visible portion of the tumor, like the tip of an iceberg. If these roots are not removed, the cancer will recur.
	The visible portion of the skin cancer is surgically removed.
	After the tissue is removed, it is color coded with a dye and divided into sections and a map is drawn.
	The undersurface and edges of the tissue are carefully examined by Dr. Adelman under the microscope to make sure all the skin cancer is out.
	If all the cancer is not out, Dr. Adelman marks the exact area on the map where the cancer persists, and returns to the patient to remove another layer of skin, but only from precisely where the cancer cells remain. This way no more tissue than absolutely necessary is taken out.

The removal process stops when there is no longer any evidence of cancer remaining. At this point Dr. Adelman will close the wound with the least scaring and best cosmetic result possible.

Why Bother With Mohs Surgery?

Mohs surgery cuts out the bare minimum of normal skin needed for a high cure rate (95%-99%). This is important in critical areas. Once a tumor has come back, conventional treatment (cutting out, scraping and burning, radiation) offers only a 50% cure rate. Mohs surgery is worth the bother in order to get all the cancer out and to get the smallest possible hole.