About Mohs Surgery

WHAT IS MOHS SURGERY?

Skin cancer is the most common form of cancer that develops in human beings. At ADAS, we specialize in various types of skin cancer treatment, including Mohs Micrographic Surgery, for our patients in Jacksonville, Fleming island and Ponte Vedra Beach.

Mohs Surgery refers to a advanced skin cancer removal technique that is performed by specially trained dermasurgeons. It is named after the dermatologist who perfected the procedure, Dr Frederick Mohs from the University of Wisconsin. It has a cure rate of up to 99% for certain tumors. Due to the fact that the Mohs procedure is micrographically (through microscopic evaluation) controlled, it provides the most precise method for removal of the cancerous tissue, while sparing the greatest amount of healthy tissue. For this reason, Mohs surgery usually results in a significantly smaller surgical defect and less noticeable scarring, as compared to other methods of skin cancer treatment. The Mohs Surgery procedure is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desirable for cosmetic and functional purposes. It may also be indicated for lesions that have recurred following prior treatment, or for lesions which have the greatest likelihood of recurrence.

WHAT ARE THE SPECIAL QUALIFICATIONS OF THE MOHS SURGEON?

Physicians performing Mohs surgery should have specialized skills in dermatology, dermatologic surgery, dermatopathology, and Mohs Surgery. Basic and advanced training in Mohs surgery is available through selected residency programs, specialized fellowships, observational preceptorships, and intensive training courses. In addition, the Mohs surgeon must have the required surgical and laboratory facilities and must be supported by a well-trained Mohs nursing and histotechnological staff. Dr Harvey is a recognized Fellow of the American Society for Mohs Surgery and has performed over one thousand five hundred cases of this type of surgery. He also peer reviews other cases sent to him by doctors throughout the country.

HOW IS MOHS SURGERY PERFORMED?

Step 1. Removal of tumor

A detailed Mohs map is subsequently drawn out with a skin-marking device. The specimen is color-coded and the tissue is frozen by our lab technician. Thin slices of the removed skin are placed on a slide. This process may take from 20 minutes to 90 minutes and is the most time consuming part of the surgery.

Step 2. Tissue is inked and placed on chuck


Step 3. Tissue is frozen and thinly sliced


Step 4. Mohs Surgeon (Dr. Harvey reads pathology)

Our surgeons will then examine the skin cancer under the microscope. All microscopic roots of the cancer are pinpointed. If skin cancer is not seen at the base or edges, we will cosmetically repair the area. If skin cancer cells are found, then additional layers of skin are removed where the skin cancer is present. This process continues in stages until the tumor has been entirely removed.

HOW LONG DOES MOHS SURGERY TAKE?

Typically, most cases are completed in 1 to 4 hours. Please anticipate spending th entire morning or afternoon with us and we ask that you clear your schedule for the entire day. You are awake during the procedure as the operation is carried out using local anesthesia. Please make arrangements to stay the entire morning or afternoon with us. Mohs surgery is performed with the patient awake as an outpatient procedure

WILL THE PROCEDURE LEAVE A SCAR?

Yes. The Mohs technique, however, allows for the smallest surgical scar possible. Once margins are clear, the surgical closure is initiated using plastic surgical techniques. In 7% of cases, your scar may need further treatment such as laser or corticosteroid injections. Our goal is to minimize your scar, but obviously this depends on a lot of issues such as location of your skin cancer, your health (do you smoke or are you on medications which have negative impacts on healing), and how well you take of your surgery site.

WHAT HAPPENS AFTER MOHS SURGERY IS COMPLETED?

Our surgeons will discuss with you what type of wound closure would be best, e.g., flap, graft, linear repair, etc. Sometimes it is best to leave the wound open to naturally heal If the tumor is very aggressive, low-grade radiation treatments are sometimes used along with Mohs surgery to enhance the effectiveness of the procedure. Sutures are removed in 7 to 14 days.

Step 5. Plastic Closure surgery site

WILL I HAVE ANY PAIN, BRUISING, OR SWELLING?

Pain is variable but if present usually only lasts a few days. If there is discomfort, Tylenol 500 to 1000mg is all that is usually necessary for relief. Stronger pain medications can be prescribed when needed. Bruising or swelling usually resolves within 7 to 10 days.

ARE THERE ANY OTHER POST OP CARE ISSUES TO CONSIDER?

We recommend a very nice post surgical kit. It is important to stay out of intense sun for at least one week after your surgery and to minimize strenuous activity for up to two weeks. Concealing makeup, e.g. Jane Iredale™, can be used to minimize redness. Arnica can also be taken if you tend to bruise. If you have any questions, please email us or call 904-285 7546 ext 299 if you have an emergency. We will get back to you within 24 hours. If you need immediate assistance and can't reach us by phone, we recommend that you proceed to the nearest emergency room. For a list of Frequently Asked Questions, please click here.

WILL MY INSURANCE COVER THE COST OF THIS PROCEDURE?

Yes, in most instances, your insurance will cover the cost of this procedure. A facility and professional fee will be charged to your insurance carrier if your case requires a complex repair, flap or skin graft to close the wound. Please check with your insurance carrier regarding coverage, deductibles and co-pay information. If you still have questions, you may contact our billing department at 285-7546 ext 203 or email billing@adasderm.com.

Click on below banner to see Mohs Surgery slideshow as performed by Dr. Harvey

Before and After Photo Gallery