The procedure, cost and recovery: Your complete guide to Mohs surgery

By Angela S. Casey, MD

Contrary to what many believe, Mohs isn’t an acronym. Mohs surgery was actually named after Dr. Frederic E. Mohs, a general surgeon at the University of Wisconsin who invented the surgery in the 1930s.

Of course, Mohs has been refined to what it is today and now offers the highest cure rate of any skin cancer treatment option, along with an extremely low complication rate, making it an optimal treatment for many skin cancer patients.

Your complete guide to Mohs surgery

If you’re in the process of researching your skin cancer treatment options, it’s definitely worth your time to learn about Mohs surgery, and below we’ll explain everything you need to know to better help you determine if this might be the ideal treatment option for you or your loved one.

What is Mohs Surgery?

With Mohs surgery, we work to remove the skin cancer layer by layer, and during the process, examine the skin tissue under the microscope until we’re absolutely sure all the cancer cells and roots have been removed. At the same time, by using this technique, we’re able to spare as much of the healthy skin in the area as possible.

Due to this ability, Mohs surgery is often the best treatment option for patients:

• Who are concerned about the appearance of a wound and want to minimize scarring from cancers on the head or neck
• Who have cancers that are more aggressive or exhibit a more invasive pattern microscopically.
• Who don’t have any other significant health problems that would make it hard to tolerate a long day in the doctor’s office since the procedure can range anywhere from 2 to 9 hours.

An in-depth look at the Mohs surgery procedure

I often tell my patients that having Mohs surgery is comparable to having a minor dental procedure since it’s not much more involved than that. We don’t put them under anesthesia, and instead, we simply numb the area with lidocaine so they don’t feel anything at all.

On the day of surgery, the patient doesn’t have to do anything special before they come into the office. It’s a regular day; they eat a regular breakfast and take their normal medications.

At the same time, I will say, it’s a long day for the patient simply because it takes time to process that piece of skin and look at it under the microscope to make sure we’ve removed all the cancer cells. This means patients can be at our office anywhere from 2 to 9 hours depending on the aggressiveness.

As we look at that skin under the microscope, that skin is marked and mapped so we can trace exactly where the remaining cancer roots are on the patient; we’re actually mapping the pattern of the skin cancer roots as we’re going along. That way, if we go back in a second or third time, we know exactly where where those cancer roots are located.

Here’s a great video illustrating the Mohs technique:

Warning: There’s much more to skin cancer than what appears on the surface, and it’s important to remind patients that what we see on the surface is just the tip of the iceberg. Nine out of ten times when I show a patient their wound after we’ve removed a cancer with Mohs surgery, they’re extremely surprised at how big the wound is.

What to expect after Mohs surgery, including scarring

Because there are a number of different options we can use after we remove the cancer, we always evaluate the wound before determining what option will be best for the patient.

• If a small and relatively shallow wound, we let it heal on its own; it heals from the bottom up just like a scrape on the skin.
• The second option is putting stitches in the wound and bringing the sides of the wound together, leaving the patient with a linear-type scar.
• The third option is a skin flap where we use the surrounding skin to cover the wound where the skin cancer was.
• Finally, we can do a skin graft where we borrow skin, most commonly from around the ears or collar bone, and basically transplant that skin to the wound where the cancer was located.

I get a lot of questions about will this leave a scar, and the answer is yes.

Anytime we do surgery on the skin, it does leave a scar, but our goal and expectation, in almost all cases, is that we’ll be able to camouflage it to the point where others shouldn’t really be aware that anything was done.

The cost of Mohs surgery and when insurance will cover the procedure

The insurance companies and American College of Mohs Surgery have come up with what’s called “appropriate use criteria” that are used to determine whether a skin cancer is appropriate for Mohs surgery.

These criteria take into account:

• The location of the skin cancer
• The microscopic pattern
• The size of the skin cancer
• If the skin cancer has grown rapidly
• If the cancer has poorly defined borders
• The patient’s general health

More often than not, insurance will cover Mohs surgery for cancers located on the head or neck, or those that exhibit an aggressive pattern microscopically.

Insurance is also more likely to cover the procedure for those who’ve had a transplant and are immunosuppressed simply because they have a suppressed immune system, which often makes skin cancer behave more aggressively.

Insurance will not cover Mohs surgery if it’s too small, simple and straightforward; for instance, a pencil eraser-sized basal cell skin cancer on the back. They’ll tell you to go with another treatment option.

No, all Mohs surgeons are not created equal

Even more importantly, the cure rate when you have plastic or general surgeon remove a skin cancer is much lower than when you have a Mohs surgeon remove the cancer. Additionally, Fellowship-trained Mohs surgeons, like those at Center for Surgical Dermatology, have extensive training and experience in skin cancer removal and reconstructive surgery for the best outcomes, both clinically and cosmetically.

Bottom line: No one knows skin cancer, including patterns and proper treatments, better than we do because it’s all we do. All day, every day.

Contact Center for Surgical Dermatology for more information on Mohs surgery for skin cancer treatment in Westerville, OH

Center for Surgical Dermatology is the largest medical and surgical skin treatment and wellness facility in Central Ohio. Since 2007, our board-certified Dermatologists, fellowship-trained Mohs surgeons, and caring professional staff have provided patients with treatment they can trust in an environment second to none. Learn more about our state-of-the-art Dermatology Center before booking your appointment today.