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Mohs Surgery

The Mohs Step-by-Step Process

The Mohs surgery procedure seems simple: the surgeon removes the cancer, carefully checks to be sure the he or she got it all, then repairs the wound. American College of Mohs Surgery members, however, train in and practice the complex nuances of this process for years so they are prepared to handle any situation they may encounter. This page describes the steps they follow for each Mohs surgical procedure.

Mohs skin cancer surgery is the most effective treatment for most types of skin cancer

Step 1

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The roots of the type of skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur. A surgery starts with the American College of Mohs Surgery (ACMS) specialist examining the visible lesion and planning what tissue to remove.

Step 2

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The surgeon removes the visible portion of the tumor using careful surgical techniques.

Step 3

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The Mohs surgeon next removes a deeper layer of skin and divides it into sections. With the help of technicians, the surgeon then color-codes each of these sections with dyes and makes reference marks on the skin to show the source of the sections. A map of the surgical site is then drawn to track exactly where each small portion of tissue originated.

Step 4

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In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer.

Step 5

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If the surgeon finds cancer cells under the microscope, he or she marks their location on the "map" and returns to the patient to remove another deeper layer of skin — but only from precisely where the cancer cells originated. This method ensures that the Mohs surgery results in the smallest scar possible.

Step 6

The removal process stops when there is no longer any evidence of cancer in the surgical site. Because Mohs surgey removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.

At this point, the surgeon discusses the options for reconstruction, should they be required, and then the post operative care.  Mohs surgery recovery tends to be easily manageable because of the use of local anesthesia and the careful surgical techniques.

What Is Skin Cancer?

While normal skin cells grow, develop, and die in predictable cycles, skin cancer develops when skin cells grow out of control. Instead of dying, the damaged DNA within skin cancer cells causes them to continue growing and produce more abnormal cells. They also tend to invade other tissues. Skin cancer is the most common type of cancer in the US.

Causes of Skin Cancer

The primary cause of skin cancer is exposure to the ultraviolet (UV) light which damages the DNA with repeated exposure. People with chronic exposure to UV light, whether in the outdoors or in tanning booths, are at increased risk of developing skin cancer. The World Health Organization recently elevated tanning beds to its highest cancer risk category, the same rating it gives to cigarettes. Immuno-suppressed patients, such as organ transplant recipients or patients with chronic lymphocytic leukemia (CLL) are at greatly increased risk as well, because their immune systems are not as capable or warding off cancerous cells.

Types of Skin Cancer

The skin is made up of several types of cells which can be affected by distinct types of skin cancer. The 3 most common types of skin cancer, which together make up approximately 99% of diagnosed cases, are basal cell carcinoma, squamous cell carcinoma, and melanoma.  Mohs surgery can effectively treat all of these kinds of skin cancer. This section provides general descriptions of each type of skin cancer. In actuality, skin cancer can take on many variations and characteristics. If you experience any notable skin changes, consult with a dermatologist immediately.

Basal Cell Carcinoma

As the most common type of skin cancer, basal cell carcinoma accounts for about 80% of all diagnosed skin cancers. It begins in the basal cells, which are skin cells located in the lowest layer of the epidermis. This type of cancer can look like a sore that doesn't completely heal, a shiny bump, or a reddish, irritated portion of the skin in an area that is exposed to the sun, such as the head, ears, face, shoulders and chest. It usually progresses slowly and does not tend to spread to other areas of the body (metastasize). Early detection and treatment can prevent basal cell carcinoma from spreading to surrounding tissue.

Squamous Cell Carcinoma

Potentially more aggressive than basal cell carcinoma, squamous cell carcinoma forms just beneath the surface of the skin in the squamous layer. While this second most common type of skin cancer often develops on sun-exposed areas, it can develop on other areas of the body like the mucous membranes and genitals. It often looks like a thick, rough, scaly patch or a bump. The National Cancer Institute estimates that in 2010, almost 1000 people will die of cutaneous squamous cell carcinoma in the US.

Melanoma

The most dangerous of the common forms of skin cancer is melanoma. While it accounts for only about 3% of skin cancer cases, melanoma is responsible for over 75% of skin cancer-related deaths. It is estimated that almost 9000 people in the US alone will die due to melanoma in 2010. Melanoma originates in pigment-producing cells called melanocytes, which give the hair, skin, and eyes their color. Melanomas are usually black or brown, and often develop in a mole or take on the appearance of a new mole. If identified early, cure rates for melanoma are quite high. Once melanoma spreads to other parts of the body, cure rates are significantly reduced.

Payal Patel, D.O., FAOCD

Dr. Payal Patel is a Board-certified Dermatologist, and is Fellowship-trained in Mohs Micrographic Surgery and Procedural Dermatology (advanced dermatologic surgery, cosmetic and laser procedures, and advanced facial reconstructions). Dr. Patel specializes in removing skin cancer using a technique that results in excellent cure rates while ultimately achieving the best cosmetic outcome possible.

Dr. Patel is from Houston, Texas and graduated from the University of North Texas Health Sciences Center with her Doctor of Osteopathic Medicine. She completed her Internship at University Hospitals Richmond Medical Center in Ohio and Dermatology Residency at Michigan State University-Genesys Regional Medical Center, where Dr. Patel was chosen to serve as Chief Resident in Dermatology. Dr. Patel then went on to complete a competitive and prestigious ACGME Fellowship in Mohs Micrographic Surgery and Procedural Dermatology at Affiliated Dermatologists & Dermatologic Surgeons in New Jersey.

Dr. Patel is a member of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, American Osteopathic College of Dermatology, Texas Medical Association, Texas Dermatological Society, Houston Dermatological Society, and Harris County Medical Society. Dr. Patel is a staff member at St. Luke’s Hospital at The Vintage. She has published numerous articles in well-known journals and presented many lectures on various dermatology topics, including her specialty, Mohs Micrographic Surgery.

Dr. Patel looks forward to serving you for years to come.

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