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Modified Mohs Surgery

Mohs and Modified Mohs surgery are very similar procedures performed to remove certain skin cancer tumors.

Mohs Surgery

Mohs surgery, or Mohs micrographic surgery, is surgery to remove a skin cancer by cutting it out. Mohs surgery involves removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached (called clear margins).

Mohs surgery is a procedure that was developed in the 1930’s by Dr. Frederic Mohs. Today, the procedure boasts a high cure rate and is one of the best choices for treatment of skin cancer, particularly Basal Cell Carcinoma and Squamous Cell Carcinoma.

What is Modified Mohs Surgery?

Modified Mohs surgery is a form of Mohs micrographic skin surgery in which a qualified surgeon meticulously removes cancerous tissue and employs the use of a microscope to evaluate and map out skin cancers.

During the modified Mohs procedure, sections of cancerous tissue are removed incrementally. Each excision of tissue is then sent immediately to the hospital pathology lab for immediate examination or “frozen section” evaluation under a microscope. This technique is often used by surgeons in conjunction with a pathologist to “clear” a cancer intraoperatively. If the cancer extends beyond the excised tissue, the process is repeated until all cancer cells are eradicated. Since tumors are typically larger than they appear and can have roots that extend into deeper layers of tissue, it is vital that the affected area is properly mapped and examined carefully.

The traditional Mohs procedure has the patient wait while an in-house lab technician prepares each piece of excised tissue during their visit. Each specimen is reviewed by the dermatologist, and the entire process can sometimes take several hours to clear a cancer. With modified Mohs, it can take less than an hour to have the skin cancer cleared AND surrounding tissue reconstructed by a plastic surgeon. Once an “all clear” report is obtained from the pathologist at the hospital, all cancerous cells have been removed from the surgical site with a 98% accuracy. The final 100% report usually takes less than 48 hours. Plastic surgical reconstruction may begin immediately that day, or may be performed in a delayed manner. This is all covered by your medical insurance and preauthorized prior to your procedure.

Who is qualified to perform Modified Mohs surgery?

In order to perform the Modified Mohs procedure, many years of training and education must be attained. As a board certified plastic surgeon, Dr. Garazo is well qualified to perform the modified Mohs procedure and has extensive experience as a plastic and reconstructive surgeon. Honored as one of ‘America’s Top Plastic Surgeons,’ Dr. Garazo is an expert when it comes to reconstruction. The same skills he uses in cosmetic surgery will be applied to your cancer reconstruction in order to obtain the best results. Dr. Garazo understands the importance of protecting the maximum amount of healthy tissue and minimizing scarring to deliver the best possible results after healing from a modified Mohs procedure.

Once the procedure is complete and the surgery site is ready for reconstruction, Dr. Garazo may use a number of methods including skin flap or skin grafting techniques, depending on the size of the affected area. Dr. Garazo will take every measure to achieve the best possible cosmetic result from your cancer reconstruction.

Am I a candidate for Modified Mohs surgery?

If you have been diagnosed with a form of skin cancer, you may be an excellent candidate for modified Mohs surgery—a qualified surgeon must evaluate many factors when determining a course of treatment:

    • Type of cancer
    • Where the cancer occurs on the body
    • Size and complexity of tumor growth
    • Whether or not the cancer has spread into other tissues

How effective is modified Mohs surgery?

When it comes to treating skin cancer, modified Mohs surgery is extremely effective. With a cure rate of over 98%, this procedure is unparalleled in comparison to other forms of skin cancer treatment. Even when other methods have tried and failed, modified Mohs provides the highest chance of success functionally and cosmetically.

Because the surgical site is not stitched or reconstructed until all cancer cells are removed, modified Mohs surgery is also more effective at saving healthy surrounding tissue than other methods. Other skin cancer treatments remove a larger area of flesh in hopes that all cancerous tissue is removed and the surgical site is sutured. In other methods, if the excised tissue is examined and it’s clear that there are still cancerous cells, the site must be reopened and additional procedures must be done.

Modified Mohs surgery has a wonderful reputation and high cure rate when treating common types of skin cancer. Whether it is appropriate for your skin cancer depends on many factors, even beyond those discussed here.

Dr. Garazo performs modified Mohs surgery with plastic surgery reconstruction at his AAAASF-accredited surgical facility, meaning you will not have to worry about coordinating reconstruction with an outside surgeon. Everything can be done at our office.

Dr. Garazo is well-versed in this procedure and has helped thousands of patients overcome skin cancer with pleasing results.

List of additional resources:

Overview of Mohs Micrographic Surgery

http://www.skincancer.org/skin-cancer-information/mohs-surgery/mohs-surgery-saving-face