Frequently Asked Questions

 

The Skin and Mohs Surgery Center

The Skin and Mohs Surgery Center offers full-time Mohs Micrographic Surgery for the treatment of high-risk skin cancer and is recognized as one of the top treatment centers in the country. Our facility has also been awarded one of the few certified fellowship-training programs in the country for this leading-edge treatment to cure skin cancer.

Fast Facts
  • More than 1.4 million cases of skin cancer are diagnosed every year in the United States and are a direct result of sun exposure.
  • Skin cancer is a disease that affects men and women of all ages, in a variety of ways.
  • One does not necessarily have to sunbathe in order to develop skin cancer.
  • Most cases can be cured with early detection.
What is Mohs Micrographic Surgery?

Mohs surgery is a highly specialized treatment developed by Dr. Frederic Mohs and is a method for treating skin cancer that removes the diseased area with continuous microscopic control.

Not all tumors grow as perfect spheres. What is visible on the surface of the skin may be only the tip of the tumor that exists underneath the skin. There are several different modes of tumor growth that are best treated using the Mohs technique.

The keys to the Mohs technique include:

  • Serial excision of a tumor using strict anatomical orientation.
  • Examination of tissue using a microscope.
  • Mapping the exact location of the residual tumor for the total removal of skin cancer.
What is the cure rate for Mohs Micrographic surgery?

The cure rate with Mohs surgery is over 99% for most types of skin cancer. You can see a tumor on your skin. What you don’t see is what is around and under the tumor – often more cancerous cells. This specialized surgical technique combines precise horizontal sectioning with careful microscopic examination. All cancerous tissue in and around the tumor is removed.

Where do I go for the procedure?

There is no hospitalization with Mohs. The procedure is performed entirely in our outpatient surgical suites. The tissue is examined in the office. The high cure rate means fewer return visits and less need for additional treatment. And, since the area around the tumor is numbed with local anesthetic, you lose no time in recovery.

Finding skin cancer is the first step towards curing it. Mohs micrographic surgery is the next step. However, skin cancers that occur in high-risk areas such as around the eyes, ears, nose and lips, or which have recurred after previous treatment are more effectively treated using Mohs Micrographic Surgery.

Frequently Asked Questions about Mohs Micrographic Surgery

What is skin cancer?

Skin cancer is a term for a variety of growths on the skin. Other terms are skin tumor and skin malignancy.

Are there different types of skin cancer?

Yes. The most common type of skin cancer is basal cell carcinoma (sometimes referred to as basal cell epithelioma). Approximately 1,000,000 new cases are diagnosed each year in this country. Another common skin cancer is squamous cell carcinoma. The third most common skin cancer is malignant melanoma.

Are skin cancers life-threatening?

The two most common types of skin cancer, basal cell carcinoma and squamous cell carcinoma, are rarely life threatening. These tumors replace normal surrounding tissue and generally do not spread to other areas. The third most common skin cancer, malignant melanoma, can be life threatening if treated late. When discovered and treated early, malignant melanoma is curable. Basal cell carcinomas and squamous cell carcinomas never “turn into” malignant melanoma.

How is skin cancer such as basal cell carcinomas or squamous cell carcinomas treated?

There are several effective treatments for these tumors. Therapies such as freezing with liquid nitrogen, burning with electric current, surgery and radiation therapy are successful. However for tumors that have recurred following treatment or for tumors in difficult-to-treat sites, a technique of skin cancer treatment known as Mohs surgery offers the best chance for total removal. It is this type of surgery for which your doctor has referred you to our office.

What does “Mohs” stand for?

Dr. Frederic Mohs developed this technique about 60 years ago. The procedure has been modified and refined over the years. Practitioners of the technique have kept Dr. Mohs’ name in respect for his contribution. Mohs surgery has other names including Mohs chemosurgery, Mohs microscopically controlled surgery, and Mohs micrographic surgery.

What is Mohs Surgery?

Mohs surgery is a technique of skin cancer treatment in which the cancer is surgically excised, and the specimen is processed immediately so that the surgeon can examine the tissue under the microscope. If the cancer has not been completely removed, then additional tissue is excised and reviewed again under the microscope. Once the skin cancer is totally removed, the wound is closed.

How are melanomas treated?

Melanoma is a cancer that is treated surgically. When the melanoma is thin (has not penetrated deeply into the skin), surgical removal is usually the cure.

How is Mohs surgery like other surgery?

The Mohs surgeon uses conventional surgical instruments and removes malignant tissue during surgery.

How is Mohs surgery different from other types of surgery?

The difference is what happens to the tissue after it is removed. After complete removal of the obvious tumor, the surgeon removes a thin layer of normal appearing skin surrounding the tumor. A map is made of the specimen. It is then processed in the laboratory for approximately one hour. The surgeon then examines the specimen under the microscope. If cancer is present in the specimen, the Mohs surgeon marks its location on the map and then returns to the patient and removes more tissue in that area. This step is repeated, if necessary, until the tumor is completely removed.

What are the advantages of Mohs surgery?

There are two primary advantages. First, by using the microscopic examination of the tissue as a guide, the Mohs surgeon is better able to remove all of the skin cancer. Secondly, by carefully mapping out the tumor, the surgeon removes cancerous tissue and leaves behind as much normal skin as possible.

How large of a scar will I have from the surgery?

The size of the scar depends on the size of the tumor. It is often difficult to predict the size of the tumor prior to surgery.

Will I have stitches following the surgery?

There are three main ways your surgical wound may be handled:

  • Direct closure of the wound: in most instances, surgical wounds are sutured (sewn) closed.
  • Skin graft: In some instances, it is necessary to remove skin from some other site and graft it over the wound.
  • Second intention healing: The body has an excellent capacity to heal open wounds. This healing period is approximately three to six weeks depending on the size of the wound. It requires regular wound care. In addition to wound size and location, the surgeon considers other factors to determine how your wound will be handled. This will be fully discussed with you on the day of surgery.

Will I be put to sleep for the surgery?

No. The surgery is well tolerated with local anesthesia. Because the surgery may be time-consuming, the risk of prolonged general anesthesia is avoided.

How long will the surgery last?

The length of surgery depends on the extent of the tumor. Often surgery lasts half a day or longer. Much of the time is spent waiting for tissue to be processed. Bring reading materials, needlework, etc., with you to help pass the time.

What if I live far away from The Skin and Mohs Surgery Center?

If you have to travel a great distance, you may want to spend the night before surgery in Overland Park or Leawood. There are several moderately priced motels nearby. A list of these is available upon request.

Should I bring someone with me?

We highly encourage you to bring someone with you.  The nurses will give you wound care instructions after your surgery and since some sites require someone else to perform the wound care, they can go over that with them as well and answer any questions.  Even with minor procedures, some patients may feel anxious or nervous.  We can give you something to help you relax but this would require that someone else come with you and drives.  Due to the limited space in the waiting room, please try to limit family or friends to one or two persons.  This will insure your comfort as well as the comfort of other patients who will also be having surgery the same day.

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What should I wear?

Men should wear a shirt that buttons down the front. Women should wear a blouse that buttons down the front, and a skirt or slacks.

Should I eat breakfast before surgery?

Yes. Breakfast is recommended.

Should I take my regular medications on the morning of the surgery?

Yes. Take your regular medications as they have been prescribed.

Are there any medications I should avoid prior to surgery?

No.

Will my activity be limited after surgery?

Possibly, depending upon the extent of your surgery.

What are the potential complications of surgery?

Bleeding and infection are the two primary complications. Both of these are uncommon. We will discuss how to recognize and deal with these problems on the day of surgery.

What are The Skin and Mohs Surgery Center’s office hours?

The Skin and Mohs Surgery Center is open 8:00 a.m. to 4:30 p.m., Monday through Friday. Mohs surgery is scheduled Monday through Friday of each week.

What telephone number should I call for scheduling or for further details regarding surgery?

During office hours, you may call The Skin and Mohs Surgery Center at 913-451-SKIN (7546). For urgent matters after hours, you may reach the provider on call by dialing this number. The medical staff of The Skin and Mohs Surgery Center is available to assist you on the day of surgery, and to answer your questions before and after surgery.

Will my insurance cover the cost of surgery?

Under most circumstances your carrier will pay for surgery. If you are a member of an HMO, it may be necessary to obtain a referral or authorization from your primary physician. If you are in doubt about your particular coverage, please check with your insurance representative prior to your appointment. If you have specific questions regarding insurance or billing matters, please contact our office at 913-754-4944.

© 2013 Dermatology & Skin Cancer Center - 913.451.7546
D&SCC practices in conjunction with Dr. Dan Bortnick, visit his site at www.drbortnick.com