MOHS MICROGRAPHIC SURGERY

Mohs surgery, also known as Mohs micrographic surgery, is used to treat common skin cancers like basal cell carcinoma, squamous cell carcinoma, and some forms of melanoma. This procedure involves removing thin layers of skin that contain cancerous cells to be examined until only cancer-free tissues are left remaining.


What is Mohs surgery?

Mohs surgery is a specialized treatment for the total removal of skin cancer. Mohs Surgery is named in honor of Dr. Frederic Mohs, the physician who developed the technique. This method differs from all other methods of treating skin cancer by the use of complete microscopic examination of all of the tissues removed surgically as well as detailed mapping techniques to allow the doctor to remove every cancer cell.


The procedure is performed under local anesthesia in an outpatient setting. The visible cancer and a very thin layer of skin is removed from that exact location. While you are in the office, this procedure will be repeated as often as necessary to remove the cancer.



MOHS MICROGRAPHIC SURGERY

Mohs surgery, also known as Mohs micrographic surgery, is used to treat common skin cancers like basal cell carcinoma, squamous cell carcinoma, and some forms of melanoma. This procedure involves removing thin layers of skin that contain cancerous cells to be examined until only cancer-free tissues are left remaining.


What is Mohs surgery?

Mohs surgery is a specialized treatment for the total removal of skin cancer. Mohs Surgery is named in honor of Dr. Frederic Mohs, the physician who developed the technique. This method differs from all other methods of treating skin cancer by the use of complete microscopic examination of all of the tissues removed surgically as well as detailed mapping techniques to allow the doctor to remove every cancer cell.

The procedure is performed under local anesthesia in an outpatient setting. The visible cancer and a very thin layer of skin is removed from that exact location. While you are in the office, this procedure will be repeated as often as necessary to remove the cancer.


What are the advantages of Mohs Surgery?

By using these detailed mapping techniques and complete microscopic control, 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 result is: (1) the removal of as little normal skin as possible, and (2) the highest possibility for curing the cancer.


What are my chances for cure?

Using Mohs surgery, the percentage of cure is more than 99 percent for most skin cancers, even when other forms of treatment have failed. Other methods of treatment offer only a 50 percent chance of success if previous treatments have failed.


What happens the day of surgery?

Your appointment will be scheduled early in the day. Our staff will escort you into a surgical suite where the area around the skin cancer will be numbed.

Once it is numb, the visible cancer and a thin layer of tissue will be removed. This tissue is carefully mapped and coded by the doctor and taken to the adjacent laboratory where the technician will immediately process the microscope slides. You will have a temporary dressing placed over the wound and you will be free to return to the waiting room.

The surgical procedure alone takes only 15-20 minutes. However, it takes 1-2 hours to prepare and microscopically examine the tissues of each layer. Several surgical stages and microscopic examinations may be required, and you will be asked to wait in the patient waiting area between stages. Although there is no way to tell before surgery how many stages will be necessary, most cancers are removed in three stages or less.

We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material to occupy your time while waiting for the microscope slides to be processed and examined. Magazines will be available in the waiting room area. The most difficult part of the procedure is waiting for the results of the surgery. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you plan to be in the office the entire day.


Will the surgery leave a scar?

Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we will decide on the most appropriate method of repair. This decision is based on the safest method that will provide the best cosmetic result.


Will I have pain after surgery?

Most patients do not complain of pain. If there is any discomfort, Tylenol is all that is usually necessary for relief. Avoid taking aspirin-containing medications as they may cause bleeding.


Will my insurance cover the cost?

We accept assignment on most major insurances and Medicare policies. Expenses not covered include insurance deductibles and co-pay amounts and occasionally office visits. Please check with your insurance company if you have any questions about coverage or pre-authorization.

Please contact your insurance company before surgery if prior authorization is required.



PREPARING FOR SURGERY


Medical History

Upon arrival at our office you will be asked to complete a medical history form. Please bring a complete list of medications including the dosage and how often you take it or bring your bottles. Please avoid wearing makeup and perfume on the day of surgery.


Medications

Continue any medications prescribed by your doctor. If you are taking prescription blood thinners, such as Coumadin, Plavix, Xarelto, Eliquis, etc or you are taking aspirin under a doctor's orders, please continue these medications. Please notify our office with the name of the blood thinner you are taking prior to surgery. If you are on Coumadin (Warfarin), we will need you to have your INR levels checked within one week prior to surgery. You may take Tylenol anytime before surgery if needed for pain. In addition, alcohol will also promote bleeding, so avoid alcoholic beverages 48 hours before surgery.


Transportation

Depending on the location of the skin cancer it may be necessary that you arrange to have a companion drive you to and from the doctors's office. You may also be more comfortable with someone to keep you company in the waiting room.


Breakfast

The day of surgery, we suggest that you eat your normal breakfast.



AFTER SURGERY


Will I need to come back?

Usually at least one return visit is needed to examine the healed surgical site or to remove stitches. Afterwards, you may return to your referring physician for routine check-ups.

A follow-up period of five years for the treated cancer is essential. After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your referring physician at least once a year, not only to examine the treated skin cancer, but also to check for new skin cancers.


How can I protect myself from developing more skin cancer?

The best protection from skin cancer is to avoid the harmful ultraviolet rays of the sun. Even if you tan easily, the sun can contribute to skin cancer in two ways. First, the sunlight damages the genes that control cell growth, and second, sunlight damages the body's immune system so that early cancers grow unchecked by normal immune defense.

Minimize your exposure by:

  • Using any sunscreen with a sun protective factor (SPF) of at least 30, with UVA/UVB protection when you spend any time in the sun.
  • Avoid sun exposure during mid-day hours (10 a.m. to 4 p.m.).
  • Do not stay outdoors unprotected on cloudy days since the ultraviolet light penetrates easily through the clouds.
  • Report changing lesions or new spots to your dermatologist. Regular check-ups are important to monitor for new skin cancers.


ABOUT OUR DOCTORS


Richard Lewis
Richard Lewis
MD, FAAD

Richard Lewis, M.D. grew up in Greenville, North Carolina and graduated Cum Laude from Wake Forest University. He received his medical degree from East Carolina University School of Medicine, and was elected into the Alpha Omega Alpha Honor Society. He completed an internal medicine internship at East Carolina University and trained in dermatology at the Medical College of Virginia, where he served as chief resident. His fellowship training in Mohs Micrographic Surgery was completed at the Medical University of South Carolina, under the direction of Dr. Pearon Lang, who spent part of his training with Dr. Frederic Mohs. Dr. Lewis is Board Certified in Dermatology, a fellow of the American College of Mohs Surgery, and a member of a number of professional societies. Dr. Lewis has been performing Mohs Micrographic Surgery since 2002.


Randal Proctor
Randall Proctor, Jr.
MD, FAAD, MBA

Randall Proctor, Jr.; M.D. grew up in Wilson County, North Carolina and graduated Cum Laude from East Carolina University. He received a masters degree and his medical degree from East Carolina University and The Brody School of Medicine, where he served as president of his class for four years. Dr. Proctor completed an internal medicine internship and a residency in Dermatology at Vidant Medical Center ancd ECU, where he served as chief resident in his.final year at ECU. Ultimately, he completed fellowship training in Mohs Micrographic Surgery at Surgical Dermatology Group in Birmingham, Alabama under the direction of Dr. Chris Harmon. Dr. Proctor is Board Certified in Dermatology and a fellow of the American College of Mohs Surgery, as well as other professional societies.