Mohs Micrographic Surgery

Delivering the highest rate of cure of any surgical procedure for the treatment of skin cancer, this surgical approach minimizes the amount of healthy tissue lost and maximizes the functional and cosmetic outcome of the surgery.

Our Mohs surgeons have the expertise and training required to treat different types of skin cancer effectively. That way, we can help preserve our patient’s healthy skin and ensure the best cosmetic outcome possible. As a result, everyone who comes to us for a Mohs skin procedure receives quality care. We pride ourselves on the level of skill exhibited by our Mohs surgeons.

We have surgery centers in Annapolis, Bethesda, Prince Frederick, Owings Mills, Westminster and Hagerstown, Maryland and Fairfax, Virginia. All are staffed by surgeons specially trained in Mohs Micrographic Surgery, who combined, have performed thousands of Mohs procedures. In addition to serving our own patients, our surgeons welcome referrals for Mohs treatment from many other area dermatologists as well as general physicians.

What is "Mohs Micrographic Surgery"?

The visible portion of the tumor is removed, then working outward from the affected area, a thin layer of skin is removed at a time. The tissue is immediately evaluated under a microscope to determine the extent of the cancer. Successive layers are removed only where necessary, until no tumor is present. This complete, systematic microscopic search for the “roots” of the skin cancer, offers a 97% – 99% chance for complete removal of cancer without an excessive loss of normal tissue. As a result, Mohs Micrographic Surgery is very useful for large tumors, tumors with indistinct borders, tumors near vital functional or cosmetically important areas, and tumors for which other forms of therapy have failed. However, no surgeon or technique can guarantee a 100% chance of cure.

In a 5-step process, Mohs surgeons use a complete microscopic examination of surgically removed tissue and detailed mapping techniques that allow him or her to track and remove all roots and extensions of the skin cancer.

What is "Mohs Micrographic Surgery"?

The visible portion of the tumor is removed, then working outward from the affected area, a thin layer of skin is removed at a time. The tissue is immediately evaluated under a microscope to determine the extent of the cancer. Successive layers are removed only where necessary, until no tumor is present. This complete, systematic microscopic search for the “roots” of the skin cancer, offers a 97% – 99% chance for complete removal of cancer without an excessive loss of normal tissue. As a result, Mohs Micrographic Surgery is very useful for large tumors, tumors with indistinct borders, tumors near vital functional or cosmetically important areas, and tumors for which other forms of therapy have failed. However, no surgeon or technique can guarantee a 100% chance of cure.

In a 5-step process, Mohs surgeons use a complete microscopic examination of surgically removed tissue and detailed mapping techniques that allow him or her to track and remove all roots and extensions of the skin cancer.

5 Step Process

Step 1

A surgery starts with the American College of Mohs Surgery (ACMS) specialist examining the visible lesion and planning what tissue to remove. The patient then receives local anesthesia, and the Mohs surgery begins.

Step 2

The surgeon removes the visible portion of the tumor using careful surgical techniques.

Step 3

He or she next removes a deeper layer of skin and divides it into sections. With the help of technicians, the surgeon then color-codes each of these sections with dyes and makes reference marks on the skin to show the source of the sections. A map of the surgical site is then drawn to track exactly where each small portion of tissue originated. In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer.

Step 3

He or she next removes a deeper layer of skin and divides it into sections. With the help of technicians, the surgeon then color-codes each of these sections with dyes and makes reference marks on the skin to show the source of the sections. A map of the surgical site is then drawn to track exactly where each small portion of tissue originated. In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer.

Step 4

If the surgeon finds cancer cells under the microscope, he or she marks their location on the “map” and returns to the patient to remove another deeper layer of skin – but only from precisely where the cancer cells originated. This method ensures that the Mohs surgery results in the smallest scar possible.

Step 4

If the surgeon finds cancer cells under the microscope, he or she marks their location on the “map” and returns to the patient to remove another deeper layer of skin – but only from precisely where the cancer cells originated. This method ensures that the Mohs surgery results in the smallest scar possible.

Step 5

The removal process stops when there is no longer any microscopic evidence of cancer in the surgical site. Because Mohs surgery removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.

What is the Cure Rate?

The cure rate with Mohs Micrographic Surgery is higher than 99%. In previously treated cancers in which the tumor is recurrent, Mohs surgery is 95% effective.

Frequently Asked Questions

Q: What kind of follow-up will I need?

A: From babies with potentially dangerous birthmarks to teenagers with acne, our dermatologists provide compassionate care — reassuring parents and minimizing discomfort in small children while restoring confidence in teens with acne. Our specialist uses their expertise to properly diagnose our youngest patients.

Q: Will I need a pre-operative visit?

A: A pre-operative visit is sometimes scheduled, especially for more significant skin cancers or for any patient who would like to be seen before surgery. This visit will allow you to meet your doctor and medical staff. An examination of cancer will be performed, and medical history will be obtained.

Q: What are the risks of surgery?

A: Although your surgeon will remove as little tissue as possible, there are some general risks associated with surgery. Your doctor will discuss these and any additional problems explicitly related to your situation.

Q: Will the surgery leave a scar?

A: Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Also, complete healing of the surgical site may take up to 12 months. During this time, the surgical site may appear red or may feel swollen or lumpy, particularly in the first few months.

Q: What are the advantages of Mohs Micrographic Surgery?

A: By using microscopic examination with detailed mapping, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The results are: 1) The removal of as little normal skin as possible & 2) The highest possible cure rate for the cancer.

Q: What happens after the skin cancer is removed?

A: Immediately after the cancer is removed, a decision is made for the best method to reconstruct the wound created by the surgery. Most frequently, the wound is closed with stitches in a side-to-side fashion, by a skin graft or by a skin flap. Most patients will not require further procedures after the repair of the surgical defect. However, some repairs are completed in two stages, with the second stage occurring two or three weeks after the initial surgery.

Preparation for Surgery

1) Shampoo your hair the night before or morning of surgery, as your wound and initial dressing has to remain dry for 24 hours after surgery.

2) If the skin cancer involves the eye and nose area, we suggest you have a driver on hand because of vision impairment due to excessive bandaging.

3) The average length of time patients spend at the surgery center is four hours; you should plan to spend most of the day at the surgery center.

4) Due to the limited space in our waiting room, we ask that you have no more than one person accompany you on the day of surgery.

5) We do have refreshments available for your comfort; however, we do recommend that you bring lunch and any medications you may need throughout the day.

6) If you smoke, try to cut down or quit prior to your procedure and for at least two weeks afterwards. This will impact how quickly you heal, as well as the appearance of the scar.

7) Be well rested and eat a good breakfast, unless directed otherwise. 8) Take your usual medications, unless directed otherwise.

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