Mohs Micrographic Surgery

What is Mohs?

Mohs is an advanced treatment procedure for skin cancer and offers the highest potential for cure – even if the skin cancer has been previously treated. This procedure relies on the microscopy by the performing surgeon to ensure the removal of skin cancer down to its roots. Mohs Surgery allows the surgeon to see beyond the visible disease and to precisely identify and remove the entire tumor, leaving healthy tissue intact. Mohs surgery is most often used in treating two of the most common forms of skin cancer: Basal Cell Carcinoma and Squamous Cell Carcinoma.

Mohs is usually recommended when a BCC or SCC is:

• Aggressive or large
• In an area with little tissue beneath it (e.g., eyelid, nose, ear, scalp, genitals, hand, or foot- and face, neck and chest)
• Recurrent

Who Performs Mohs in our office?

Newport Beach Dermatology and Plastic Surgery has been performing Mohs surgery since 2010.  We have three certified Mohs surgeons who are Diplomates of the American Board of Dermatology, a Founding Member of the American Board of Medical Specialties.  Larisa Lehmer, M.D. FAAD, Robin Lewallen M.D. FAAD and Anne Marie McNeill M.D. Ph.D. all have satisfied this requirement and practice Mohs extensively in our office.

What to expect during Mohs surgery?

1. The visible tumor and a thin layer of surrounding skin are removed.
2. The tissue is examined under a microscope to see if any cancer cells remain at any of the edges.
3. If any cancer cells remain, additional skin is removed in the area identified and examined under the microscope.
4. This process continues until no more cancer cells are found at the edges.

The cure rate for Mohs Micrographic Surgery is the highest of all treatments for skin cancer – up to 99 % even if other forms of treatment have failed. This procedure is the most exact and precise method of tumor removal and minimizes the chance of re-growth and lessens the potential for scarring or disfigurement. Either Board Certified Plastic Surgeon Christopher Ellstrom M.D. or Board Certified Dermatologist Larisa Lehmer M.D. will perform the closure for the defect.  Closure is the act of moving skin into the site where the cancer was removed.  Dr. Ellstrom, Dr. Lehmer, and Dr. Lewallen all perform closures.   It is normal for the day of Mohs to be a long one.  Plan on being here anywhere from 2-6 hours.   If you are wanting to see a Mohs procedure in our office there are 2 examples on our Instagram page under the Mohs tab.  @NBDPS

So you just had Mohs…What can you expect?

It’s possible the site can be numb for several hours after you leave our office.  Additionally, swelling for a few days is normal, redness, and soreness are common.  The site itself can appear tight and the skin at the suture can appear “caterpillar-like”.  This is intentional as the site will pull and loosen over time.  It is important to follow your doctor’s instructions which are likely to clean the site daily with a gentle cleanser, re-apply an ointment like Polysporin, Aquaphor, or Vanicream ointment, and a bandage for a few days.  For a repair on the hand, you may be asked not to lift anything over 2 pounds.  For the low leg and feet, you may be asked to try and elevate.  For the face, you may be unable to keep the bandage on, so listen to your doctor carefully for instruction when you are leaving our office as they may have different instructions for you.

For most sites, suture removal is the following week.  If it is the leg it may be two weeks.  If there are both absorbable and non-absorbable sutures used, the absorbable sutures will be left to absorb naturally over the next three months.  However, it is not unusual for bits of the suture to stick out and they may need to get pulled out after weeks or even months later.

It’s a good idea to use sunscreen as often as needed and to apply a scar gel-like Strataderm, which we sell on our website https://www.newportbeachdps.com/product/strataderm-2/  and in our office.

Why does my Mohs site still look red?

It’s been a few months and you’re wondering, “Is this as good as it gets?”  Well, if it’s been 9 months, you likely have healed as much as possible without more medical help.   Please come to see us if you have any issues with your site.  There are a few different things we may be able to do to help improve the scar.  We can use lasers, like our Excel V  or CO2 https://www.newportbeachdps.com/services/co2re-fractional-c02-resurfacing-system/ to help improve the tone and/or texture of the scar.  Injecting the scars with a steroid may be recommended to help flatten and break up scar tissue.  But remember, it takes a full 9-12 months for natural scar remodeling to take place.  This is true for Mohs, excisions, and even biopsies.