Warrenton Dermatology Skin Surgery Center

Mohs Surgery

Mohs micrographic surgery is the most effective and advanced treatment for skin cancer. It is performed on an outpatient basis using a highly specialized and precise technique that surgically removes the cancerous tissue in stages, one tissue layer at a time. This technique allows physicians to precisely identify and remove the entire tumor while leaving as much of the surrounding healthy tissue as possible intact and unharmed. Mohs surgery also offers the highest potential for successful cure, even if the cancerous tissue has been previously treated by another method.

To ensure that your skin cancer treatment is performed to the highest standards of quality and competency at the Warrenton Dermatology Skin Surgery Center, Mohs micrographic surgery is only performed by American Academy of Dermatology (AAD) and American College of Mohs Surgery (ACMS) fellowship-trained surgeons. Our board-certified specialists are dedicated to providing you with the highest quality of care, using state-of-the-art technology, in a friendly and comfortable environment.

The cure rate using this surgical method for new basal cell and squamous cell carcinomas exceeds 98%. This is superior to any other treatment modality, including simple excision, radiation, and chemotherapy. As a result, Mohs micrographic surgery has proven extremely useful for treating large tumors, tumors with indistinct borders, tumors near vital functional or cosmetic structures, rare skin cancers, and tumors for which other forms of therapy have failed.

Learn more by watching this video produced by the ACMS:

The process involves first removing the visible portion of the tumor by excision or curettage, and then performing a systematic search for the “roots” of the skin cancer by excising one thin layer of tissue at a time (1-2mm thick), mapping each tissue sample to orient it top-to-bottom and left-to-right, and then examining it microscopically to determine if any portion of the tumor remains in that layer of tissue. If so, its precise location is established, and an additional thin layer of tissue is then excised from that exact spot, and the process is repeated until no trace of tumor is found.

The Warrenton Dermatology Skin Surgery Center is a referral center committed to working with you and your referring physician to provide specialized care and treatment of your skin cancer. For more information, please call 540-701-4656.

To learn about other forms of skin surgery, CLICK HERE

Mohs Surgery FAQs

History of the Mohs Surgery Technique

In 1935, Dr. Frederic Mohs developed a technique for cancer removal known as chemosurgery. Originally, chemicals were applied to the skin during the surgery, causing the cancer to be destroyed in a selective fashion. These chemicals are now rarely used, but the name Mohs continues to be associated with the procedure of selectively removing cancerous tissue - now correctly termed Mohs micrographic surgery, reflecting the use of microscopic margin control for each layer of tissue taken.

How long will the surgery last?

The length of surgery depends on the extent of the skin cancer. Often surgery lasts approximately a half day or longer. Much of your time is spent waiting for tissue to be processed. Bring reading materials, electronic devices (e-reader, iPad, tablet, etc.). Also, bring a snack or lunch with you on the day of surgery.

What happens after the skin cancer is removed?

Immediately after the cancer is removed, a decision is made for the best method of repairing 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. Occasionally, when the wound is small enough, no stitches are required, and the wound can heal on its own. 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 to three weeks after the initial surgery.

Infrequently, a tumor may turn out to be much larger than anticipated. Under these circumstances, another specialist completes the reconstruction, and it may take place on the same day or on a subsequent day.

Will the surgery leave a scar?

Yes. However, because Mohs surgery removes as little healthy tissue as possible, scarring is minimized. Also, the surgical site may appear red or may feel swollen or bumpy, particularly in the first few months post-procedure. We recommend that the site be gently massaged beginning 4-6 weeks after the procedure to help break up scar tissue, and redness typically self-corrects over time.

Will I have pain after surgery?

Most patients do not have significant discomfort after surgery. Any pain post-surgery typically responds to over-the-counter extra strength Tylenol (acetaminophen). You may have some swelling and bruising around the wound, especially if the surgery is around the eyes or mouth.

What are the risks of surgery?

• As tumors are often larger than their surface appearance indicates, the wound after the complete removal of the cancer may be larger than anticipated.

• We make every effort to obtain an optimal cosmetic appearance after surgery. With any excisional surgical procedure, scarring will occur at the site of removal.

• Occasionally, the surgical site may be slow to heal, grafts or flaps may fail, or the repair may re-open after closure. The most common risk factors include smoking, diabetes, bleeding, poor physical condition, or other disease processes.

• Skin cancer can involve nerves. With the removal of skin cancer, there may be local numbness or less common, loss of local muscle movement after the procedure.

• Occasionally, nearby nerves can be injured during the reconstruction of the defect following surgery. For sensory nerves, sensation will usually return over a time period of up to 24 months. Motor nerves are less likely to have a return of function. For damage to major nerves, microsurgical repair may be required to salvage function.

• No procedure can guarantee that the cancer will never come back. With Mohs surgery, however, your cure rate will be maximized. Previously treated tumors and large, longstanding tumors have the greatest chance of recurrence. Although infection is rare, it can occur. Make sure that you follow your wound care instructions carefully and care for your surgical site as directed.