By: Dr. Angela Casey Basal cell carcinoma is the most common form of skin cancer.…
Hearing your doctor say the “C” word is stressful and scary, even for cancers with an excellent prognosis, like squamous or basal cell carcinomas. If you’ve decided to have Mohs surgery to remove your skin cancer, you should seek out a Mohs surgeon who can provide the best possible outcome both surgically and cosmetically.
In this article, we’ll share the top things you should consider when choosing a Mohs surgeon, as well as the benefits of choosing a Fellowship-trained surgeon to perform your skin cancer removal surgery.
Top considerations when choosing a Mohs surgeon
Whenever possible, select a Mohs surgeon who performs the surgery in-office or in an ambulatory surgical center. These convenient outpatient locations have much lower infection rates than hospitals, and they use local anesthesia rather than general, so patients have a much quicker postoperative recovery. Additionally, the cost of the procedure is typically much lower, which reduces the financial burden on patients.
It’s also wise to choose a dermatologist who has received board-certification because it means that they’ve met rigorous standards for education and dermatological practice. Before selecting your Mohs surgeon, you should also check with the clinic to be sure that they accept your health insurance policy.
Finally, you should select a dermatologist who has participated in Fellowship-training for Mohs surgery if possible, rather than Society-based training.
Fellowship-trained vs. Society-based: What’s the difference?
Two common ways that dermatologists train to become specialists in Mohs surgery are through the American College of Mohs Surgery (Fellowship training) and through the American Society for Mohs Surgery (Society-based).
Requirements for Fellowship training
Frederic E. Mohs invented Mohs surgery, a method of removing cancerous tissue one layer at a time, in the 1930s. He founded the American College of Mohs Surgery (ACMS) in 1967 to train other doctors in his method of precise skin cancer removal. The process for dermatologists to receive admittance into the Fellowship training program is highly competitive.
To become an ACMS Fellow, physicians who have finished their residency complete one to two years of additional hands-on training in Mohs surgery with the mentorship of a highly qualified instructor(s). The fellowship training programs are regulated and reviewed to ensure that physicians in training receive a comprehensive education, including skin cancer removal with the Mohs procedure and reconstructive surgery techniques to obtain excellent functional and cosmetic outcomes.
The ACMS works consistently to maintain the highest standard of care and training for any of the physicians that undergo the fellowship. Under expert supervision, candidates practice a minimum of 500 Mohs surgery cases. They receive training in common skin cancers (such as basal cell carcinomas and squamous cell carcinomas) as well as rare tumor pathology so that they can accurately analyze the tissue that they remove during surgery.
A Fellowship-trained Mohs surgeon has experience removing tumors in difficult locations and performing complex wound reconstruction, as well as successfully dealing with surgical complications and cancer recurrence. Patients rarely need to see a separate physician for reconstruction when they choose a Fellowship-trained Mohs surgeon because they are experts in providing cosmetically pleasing outcomes.
The stringent requirements to become an ACMS Fellow ensure that Fellowship-trained Mohs specialists are highly experienced, competent surgeons who will provide optimal outcomes for patients.
A group of physicians formed the American Society for Mohs Surgery (ASMS) in 1990 after receiving Mohs training during their dermatology residency. The goal of the organization is to provide education and training to physicians who have not undergone extensive training in Mohs surgery. The requirements to join the ASMS are significantly less rigorous than admittance into the ACMS. Society-based surgeons need only complete 75 Mohs cases, 45 of which they could have performed during their dermatology residency.
Doctors need two letters of recommendation from board-certified dermatologists and need to submit 2 Mohs cases that they performed post-residency. The cases need to include tissue slides, the Mohs map, a report, and patient photos. They also need to score 70% or higher on an exam that includes both written and practical portions. Then, they must participate in the ASMS peer review program for four years.
Choosing a Society-based surgeon certainly doesn’t guarantee that your Mohs surgery will have a poor outcome. However, when it comes to cancer, you shouldn’t settle for less than the best.
Mohs surgery at Center for Surgical Dermatology
All of our Mohs surgeons are board-certified and Fellowship-trained members in good standing of the ACMS. You can beat cancer at the Center for Surgical Dermatology. If you have a suspicious spot or mole, schedule an appointment with one of our physicians today.