Surgery

The Providers at Bellaire Dermatology are well trained in surgical options for removing worrisome lesions. A variety of treatment options may be used, depending on the location and severity of the suspicious lesion. Once removed, our team will send it to the dermatopathology lab for microscopic examination.

The Providers at Bellaire Dermatology are leaders in surgical dermatology offering a variety of treatment options to remove worrisome lesions. Once removed, our in-house dermatopathology lab performs microscopic examination.

MOHS micrographic surgery is an advanced treatment process that provides the most effective technique for removing skin cancers while minimizing the sacrifice of normal tissue. This technique provides a 99% cure rate for most cutaneous tumors while allowing an optimal cosmetic outcome.

With both a MOHS surgeon, Dermatopathology Lab, and Clinical Staff in house at Bellaire Dermatology, we can make the MOHS process both quick and as easy on the patient as possible!

What is Skin Cancer?

Skin cancer is a common tumor seen with a greater frequency as we age and receive more sun exposure. The most common types of skin cancer are: basal cell carcinoma, squamous cell carcinoma, and melanoma. Treatment options for skin cancers include MOHS surgery (explained below), excisional surgery, x-ray, surgery, curettage, and freezing (cyrosurgery). The type, location, and characteristics of the skin cancer dictate treatment options.

What Causes Skin Cancer?

Cumulative sun exposure is the single most important factor associated with the development of skin cancers. Fair skinned people often develop skin cancers more frequently than those with darker skin tones. Skin cancers also tend to be hereditary and may occur more commonly in certain families. Other possible factors contributing to the development of skin cancer include prior x-ray treatment, trauma, smoking, tanning bed use, immunosuppression, and certain chemicals.

How Does Skin Cancer Grow?

Skin cancer begins in the uppermost layer of the skin and can gown down-ward like roots and/or outward horizontally along the skin surface. Therefore, what is apparent to the naked eye on the surface of the skin may only be the “tip of the iceberg.”

Is My Skin Cancer Dangerous?

The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. Both types grow slowly at their point of origin and usually do not spread to distant parts of the body. If not completely removed, both types can eventually cause problems such as bleeding, pain, local destruction of tissue, distant spread and death. Compared to other types of cancer, basal cell carcinoma and squamous cell carcinoma are far less serious as long as they are treated in a timely manner.

Melanoma can be life threatening if not treated early. It usually appears as a brownish-black spot on the skin which often enlarges, grows, or changes. They can also begin as normal moles which have been present for years. With these, it is important to monitor for changes in texture, color, and border.

FAQs About MOHS Micrographic Surgery

What is MOHS Micrographic Surgery?

MOHS micrographic surgery is a highly specialized technique for the optimal removal of certain types of skin cancer. It is the treatment of choice for difficult and recurrent skin cancers. Locations of the body frequently treated with MOHS surgery include the scalp, face, neck, hands, feet, and genitalia. This surgical method often allows for a 99% cure rate of the cancer. Less than 800 surgeons in the world are trained in this technique where one physician acts as the oncologic surgeon, pathologist, and reconstructive plastic surgeon. MOHS Surgery is performed in the office (not an operating room). To perform MOHS Surgery, the site is locally numbed with an injected anesthetic. No general sedation is needed. If a patient is extremely anxious or nervous, we offer “laughing gas” to help calm him/her.

Once the skin is numb, the surgeon excises the visible portion of the skin cancer. The skin cancer is removed one layer at a time and analyzed microscopically while you are in the office. Once the skin layer is removed, it is stained and carefully diagrammed. It is then processed immediately in the office by the lab histo-technician who converts the tissue into micrographic slides. These slides are then reviewed by Dr. McNiece to determine if all of the malignant cells have been removed. If there is residual tumor, the MOHS surgeon can determine precisely where it is located since the tissue was previously diagrammed. The exact area where the tissue persists is then removed by taking another layer of tissue, and the process is repeated. The surgery itself takes only several minutes; however, the tissue processing takes 45 minutes. Once all of the margins are free of cancer, options for healing/stitches are discussed.

What are the advantages of MOHS surgery?

The MOHS micrographic technique offers the highest possible cure rate (up to 99% for many primary skin tumors) for the treatment of skin cancer, compared to other therapeutic modalities. Using complete microscopic examination, the MOHS Surgeon pinpoints areas involved with cancer and selectively removes only those areas. MOHS surgery allows the physician to remove as little normal tissue as possible around the tumor, and thus in many cases can provide a superior cosmetic result. Another advantage is that MOHS surgery can be performed under local anesthesia in an out-patient setting. Therefore, even with large skin cancers, hospitalization can usually be avoided.

Before & After MOHS Surgery

Does My Insurance Cover MOHS Surgery?

MOHS Surgery is an outpatient surgery just as if it were performed in an outpatient clinic. We accept Part B Medicare which should reimburse charges at 80% of Medicare’s allowed amount. If you have a supplemental policy, it will also be filed and usually pays the remaining portion of your bill. For those who do not yet have Medicare, the amount that your policy will pay toward the cost of surgery varies with the type of policy you have. If you should have any questions concerning coverage, please discuss this with our billing department.

How long should I plan on spending in the doctor's office?

The length of time depends largely on the size of your skin cancer and the number of layers that are required. You can expect to stay at least two to four hours, however, some patients may be required to stay longer. Remember that the major goal of the procedure is to achieve 100% removal of all of the tumor cells. The removal of the entire skin cancer will be completed during your office visit.

What happens at a MOHS Surgery Pre-Op Visit?

The Pre-operative visit allows Dr. McNiece the opportunity to examine your skin, obtain your medical history and determine whether the technique of MOHS surgery is the best option for treating for your skin cancer. Also, it gives you a chance to learn and ask questions about your procedure. Every skin cancer is different, and we want to make sure that your treatment is perfectly tailored to you.

A pre-operative visit is not mandatory, but often times provides for the best surgical day experience.

How Should I get Ready for MOHS Surgery?

Try to get a good night’s rest and eat a good breakfast. Please bring all of your medicines in their original containers and/or a complete list of the medicines you take. Please continue taking all of your medications as directed unless otherwise advised.

It is a good idea to bring a book or magazine with you on the day or surgery. Also, you may desire a jacket or sweater in case you get cold in our surgical suites. It may be relaxing to have company with you while you are in the waiting room – feel free to bring a friend or loved one.

Download our MOHS Surgery Checklist Here

What can I expect the day of surgery?

When you arrive for surgery, Dr. McNiece’s team will bring you to our surgical suites (across the hall from the main medical dermatology office). After ensuring your comfort, Dr. McNiece and staff will identify your skin cancer, gently anesthetize the area of local anesthetic, and proceed with removal.

Once the skin cancer has been removed, a surgical assistant will cover your wound with a bandage and escort you to the waiting room (stocked with snacks and drinks). At times, the wait may take approximately 45-60 minutes. During this time, the skin cancer is carefully prepared by our lab histotechs, and Dr. McNiece studies all of the skin cancer margins. If your tissue still contains cancer cells, the above procedure will be repeated as soon as possible. The procedure is repeated as many times as necessary to completely remove the skin cancer. The average number of surgical sessions is 2 or 3; so most patients have their entire skin cancer removed by late morning. However, many are cleared after 1 session.

During the wait time, you will be able to read, nap, go to the restroom, snack, work, etc. You may pass the time as you desire.

What happens after the surgery is completed?

When the skin cancer has been completely removed, a decision is made on the best option for healing. These options will include:

  • Closing the wound with stitches
  • Letting the would heal by itself
  • Closing the wound with a skin graft or flap

We will recommend which of these methods will be best for your individual case. Repairs may be completed by us or by other surgical specialists. Each patient is unique and we must individualize your treatment to achieve the best result.

You may experience a sensation of tightness (or drawing) as the wound heals, but this is normal. As time progresses, you will feel less and less. Also, you may experience local numbness around the surgical site as nerves will be disrupted during the procedure – this sensation usually resolves over the course of several months. In rare cases, the numbness may be permanent. Any form of surgical procedure will leave a scar, but we always attempt to minimize the size and optimize the final aesthetic outcome. The new skin that grows over the wound contains many more blood vessels than originally (to help with the healing process). This results in a pink area around the scar that may take weeks to months to fade.

Healing wounds tend to itch. Application of petroleum jelly or mild moisturizers will help relieve the itching sensation.

Will there be any office visits after the surgery?

It will be necessary to see you routinely after the surgery for several months. The frequency of these return visits will depend upon the size and location of your skin cancer. After the short-term follow-up visits are completed, the long-term follow-up will be performed by your referring physician.

What are the alternatives to Mohs surgery?

MOHS surgery is the treatment of choice for recurrent skin cancers, large skin cancers, aggressive skin cancers that arise in skin that had previous x-ray treatment, and skin cancers near vital organs such as the eyes, mouth, nose and ears. For uncomplicated skin cancers, alternative treatments include routine surgical excision, x-ray treatments or destruction of the tumor by burning or freezing. The cure rate of these treatments is significantly less than MOHS micrographic surgery.

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