Mohs Micrographic Surgery in NYC

Mohs Micrographic Surgery in New York, NY Questions and Answers

The following has been written to answer questions about the treatment of your skin cancer by the Mohs micrographic surgical technique



PHOTOGRAPHY
If you DID NOT have your biopsy performed in our office, we would like to you to take a photograph of your biopsy site, if possible.  Oftentimes, it is difficult to identify the site without a photograph.  Please bring the photograph with you to your appointment. 

WHY CHOSE AN ACMS FELLOWSHIP TRAINED MOHS SURGEON? Skin cancer is the most common form of cancer in America and early treatment from an experienced physician is vital.  All of our Mohs Surgeons here at the Laser & Skin Surgery Center of New York undergo extensive Fellowship training under Roy G. Geronemus, M.D.  Mohs micrographic surgery is a procedure that is widely accepted as the most effective method of treating many types of skin cancer.  Fellowship training from the American college of Mohs Surgery indicates a higher level of education and skill which our physicians obtain in order to provide patients with the best possible care.  Our MOHs surgeons are amongst the most experienced in New York. In addition to their qualifications and experience, our laboratory is CLIA approved and accredited by the AAAHC. The procedures are performed in a comfortable outpatient setting with a warm and caring staff of registered nurses who assist our surgeons.  The ACMS, otherwise known as the American College of Mohs Surgery or Mohs College, was established in 1967. It was named after Frederic Mohs, MD, who developed the procedure and served as the first president of the Mohs College. From its inception, the Mohs College has promoted and continues to set the highest standards of patient care relating to management of skin cancers, Mohs surgery and reconstruction through its fellowship training process.

WHAT IS MOHS MICROGRAPHIC SURGERY? Mohs micrographic surgery is a specialized technique for the removal of certain types of 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 a specially trained technician who converts the tissue into micrographic slides. These slides are then reviewed by the physician to determine if all of the malignant cells have been removed. If there is residual tumor, it is possible to 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 anywhere from twenty minutes to one hour, and then upon examination of the slides, a decision is made as to whether or not further surgery is indicated. Each procedure where tissue is removed is referred to as a stage. The term Mohs refers to Dr. Frederick Mohs, who initiated its use in the early 1960's.

ARE THERE ANY PRE-OPERATIVE INSTRUCTIONS THAT I SHOULD FOLLOW? Aspirin, aspirin-containing products and anti-inflammatory medications (such as Advil, Nuprin, Motrin and Alleve), as well as vitamin E, should be avoided for one week prior to the surgery. If you are taking anti-coagulants or having clotting problems, please let the doctor know. You should otherwise continue to take all of your medicines and you should have a breakfast or lunch prior to the surgery. Heavy alcohol use and smoking should also be avoided for one week prior to your surgery.
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WHAT ARE THE ADVANTAGES OF MOHS SURGERY? The technique offers the highest possible cure rate for the treatment of skin cancer, compared to other therapeutic modalities.  Mohs surgery also 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 with many large skin cancers, hospitalization can be avoided by performing Mohs surgery on an out-patient basis.

HOW MANY STAGES OF SURGERY WILL I UNDERGO? The average patient undergoes two stages or procedures although 40% of all patients only require one stage.

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 stages 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 skin cancer will be completed during your office visit.

WHAT HAPPENS AFTER THE SURGERY IS COMPLETED? There will be wound following the completion of the Mohs surgery. There are several options to allow for healing. These options include allowing the wound to heal by itself, suturing through primary closure, skin grafting and skin flaps. We sometimes choose to use lasers to help the healing process at the time of the procedure and also during the healing phase. In almost all cases we perform the repair of the wound on site immediately following Mohs surgery. It is, however, always your option to select another surgeon for the reconstruction of the postoperative wound.

WILL THERE BE ANY OFFICE VISITS AFTER THE SURGERY? Yes. 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 IS A BASAL-CELL CARCINOMA? A basal-cell carcinoma is the most common type of skin cancer. It rarely metastasizes (spreads to other organs); however, if it is not removed, it can be locally destructive. It is probably caused by sun exposure or radiation therapy in susceptible individuals.

WHAT IS A SQUAMOUS-CELL CARCINOMA? A squamous-cell carcinoma is the second most common type of skin cancer, which is usually not serious unless it has been neglected. It has a slightly greater chance of metastasis than a basal-cell carcinoma, but this is still an uncommon phenomenon.

WHAT ARE THE CHANCES THAT MY SKIN CANCER WILL RETURN AFTER THE MOHS SURGERY? Mohs surgery offers the highest cure rate of any treatment method. If your skin cancer has never been treated before, then the chance of recurrence is less than 1%. If your lesion has been treated before, then there is less than a 4% chance or less of recurrence.

WHAT ARE THE ALTERNATIVES TO MOHS SURGERY? Mohs surgery is the treatment of choice for recurrent skin cancers, 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, although the cure rate of these treatments are less than Mohs surgery.


If you have any further questions, please call the office at (212) 686-7306.


Roy Geronemus, M.D., selected as a Top Cancer doctor by Newsweek Magazine - (2015)

As Culture Changed, So Did Melanoma Risk, Study Finds - NYU Langone (2014)

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