The Mohs surgical process involves a repeated series of surgical excisions followed by microscopic examination of the tissue to assess if any tumor cells remain. Some tumors that appear small on clinical exam may have extensive invasion underneath normal-appearing skin, resulting in a larger surgical defect than would be expected. It is therefore impossible to predict a final size until all surgery is complete. As Dr. Pennie utilizes Mohs surgery to treat complex skin cancers, approximately half of all treated tumors require 2 or more stages for complete excision.
Because Dr. Pennie performs Mohs surgery under local anesthesia in the comfort of her office, there is minimal preparation that needs to be done before surgery.
Anesthesia. The process begins by using local anesthesia to completely anesthetize the area around the skin cancer. General anesthesia is not required for Mohs micrographic surgery, making the procedure and recovery time shorter.
Removal of visible tumor. Once the skin has been completely numbed, the tumor is gently scraped with a curette, a semi-sharp, scoop-shaped instrument. This helps define the clinical margin between tumor cells and healthy tissue. Dr. Pennie then excises a thin, saucer-shaped “layer” of tissue around the tumor. An electric needle, “cautery”, may be used to stop the bleeding.
Mapping the tumor. Once Dr. Pennie removes a “layer”, she uses colored dyes to map the tissue to serve as a guide to the precise location of the tumor. The tissue sections are processed onto microscopic slides, which Dr. Pennie examines to determine whether skin cancer cells are present. It takes approximately 60 minutes to process, stain and examine a tissue section. During this processing period, your wound will be bandaged.
Additional stages – If Dr. Pennie observes any cancer cells present, she identifies the location and marks this on her map. She will remove an additional layer of tissue only in the area where the skin cancer is present, preserving the healthy skin. The newly excised tissue is again mapped, color-coded, processed and examined for additional cancer cells. Dr. Pennie continues the process layer-by layer until the cancer is completely removed.
Reconstruction. After the cancer has been completely removed, Dr. Pennie will discuss your options for healing and repairing the wound. As a fellowship-trained Mohs surgeon, Dr. Pennie is specially trained in advanced reconstruction. Reconstruction is individualized to preserve normal function and maximize aesthetic outcome. The best method of repairing the wound following surgery is determined only after the cancer is completely removed, as the final defect cannot be predicted prior to surgery. Sutures are used to close the wound. Some wounds may be closed side-by-side in a simple line while other might requires a flap to be designed or a skin graft placed. On occasion, a wound may be allowed to heal over naturally.
Sources: American College of Mohs Surgery for more information please log onto https://www.mohscollege.org/
In general, we do not recommend that you stop any medications that were prescribed by a doctor without checking with that doctor. Over-the-counter medications containing aspirin, ibuprofen, or vitamins should be discontinued per our instructions.
People have skin cancer for multiple reasons. The two main reasons are sun exposure and genetics. Damaging sun exposure likely took place before you were 18 years old. Although it is very important that you protect yourself now from the sun so that you do not continue to get skin cancers, your current skin cancer is due to excessive sun exposure 20 years or so back. Also, your genetic background determines how likely you are to be affected by sun damage. If you have light colored eyes, blond or red hair, and fair skin, you are more likely to have skin cancer. If you or any of your family members have had skin cancer, you are also at higher risks of developing skin cancer. For more detailed information, please visit http://www.aad.org or www.skincancerfoundation.org.
Mohs micrographic surgery involves an additional one to two years of training after residency. The Mohs micrographic surgery fellowship match is coordinated through the San Francisco Matching Program (SF Match) along with 11 other specialty fellowship matches, including craniofacial surgery, facial plastic surgery, neurosurgery, ophthalmology and pediatric otolaryngology. There are approximately 49 training programs that offer Mohs micrographic surgery training in the United States. There are 63 fellowship-trained Mohs surgeons in Florida. The American College of Mohs Surgery sponsors the fellowship-matching process. There is no substitute for additional formal training under the guidance of a mentor. Training in Mohs micrographic and reconstructive surgery cannot be mastered during short training periods such as preceptorship or residency and is best learned in a Mohs surgery fellowship.