SURGERY

The Providers at Bellaire Dermatology are well trained in surgical options for removing worrisome lesions. A variety of treatment options may be used, depending on the location and severity of the suspicious lesion. Once removed, our team will send it to the dermatopathology lab for microscopic examination.

Mohs micrographic surgery is an advanced treatment process that provides the most effective technique for removing skin cancers while minimizing the sacrifice of normal tissue. This technique provides a 99% cure rate for most cutaneous tumors while allowing an optimal cosmetic outcome.

Whether performing your Mohs surgery in our Bellaire office, or referring you out to another qualified surgeon, Bellaire Dermatology strives to ensure outstanding outcomes that promote both the health and aesthetic appearance of every patients’ skin. Mohs micrographic surgery is an advanced treatment process that provides the most effective technique for removing skin cancers while minimizing the sacrifice of normal tissue.

Mohs Micrographic Surgery remains the most effective method of removing non-melanotic skin cancer (basal cell cancer, squamous cell cancer, sebaceous carcinoma, Extramammary Paget’s disease, Dermatofibrosarcoma protuberans, etc.) available anywhere in the world today. Mohs micrographic surgery utilizes an advanced technique to take out only the affected skin and tumor and leave as much of the normal skin intact to provide the best cosmetic results. The surgeon removes affected skin tissue layer by layer while analyzing the depth of the cancerous skin cells. This ensures that the cancerous skin is entirely removed, while limiting the removal of healthy, uninvolved tissue and skin cells. Our doctors utilize the latest equipment and technology, and offer a number of in-house services and treatments, such as conventional skin cancer care, photodynamic therapy, and advanced surgical care, in addition to Mohs micrographic surgery. Having everything under one roof gives our patients superior care with internal collaboration between the treating doctor, pathologist, and surgeon. This provides seamless and efficient care for our patients.

What is MOHS?

 
Mohs micrographic surgery is a highly specialized technique for the optimal removal of certain types of skin cancer. This surgical method often allows for a 99% cure rate of the cancer. Less than 800 surgeons in the world are trained in this technique where one physician acts as the oncologic surgeon, pathologist, and reconstructive plastic surgeon.

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, the Mohs surgeon can 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.


MOHS FAQ

CMohs micrographic surgery is a highly specialized technique for the optimal removal of certain types of skin cancer. This surgical method often allows for a 99% cure rate of the cancer. Less than 800 surgeons in the world are trained in this technique where one physician acts as the oncologic surgeon, pathologist, and reconstructive plastic surgeon. 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, the Mohs surgeon can 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.
The Mohs micrographic technique offers the highest possible cure rate (up to 99% for many primary skin tumors) 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 Mohs surgery can be performed under local anesthesia in an out-patient setting. Therefore, even with large skin cancers, hospitalization can usually be avoided.
Each stage consists of the surgical removal of any visible or microscopic tumor, tissue processing, and the slide examination. The average patient undergoes two stages or procedures although 40% of all patients only require one stage.
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.
There will be a wound following the completion of the Mohs micrographic 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.
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. We may use lasers, dermabrasion, and other techniques to allow the scar to heal optimally. After the short-term follow-up visits are completed, the long-term follow-up will be performed by your referring physician.
Basal-cell carcinoma (BCC) is the most common type of cancer in the United States. More than two million people are newly diagnosed each year. This type of cancer rarely metastasizes (spreads to other organs), but it can be locally destructive. The current hypothesis is that basal cell carcinoma is likely caused by chronic or excessive sun exposure or radiation therapy in susceptible individuals. With the Mohs techinque, primary (previously untreated) BCC can be removed with a cure rate of 99%.
Squamous-cell carcinoma (SCC) is the second most common form of skin cancer. While there is a greater risk of metastasis (moving to other parts of the body) than basal cell carcinoma, SCC is usually not serious unless it has been neglected. With Mohs micrographic surgery, primary (previously untreated) cutaneous squamous cell cancer can be removed with a cure rate of 98% to 99%.
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.
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. The cure rate of these treatments is significantly less than Mohs micrographic surgery.
Aspirin, aspirin-containing products and anti-inflammatory medications (such as Advil, Nuprin, Motrin and Alleve), as well as vitamin E, should be avoided for at least 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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Medical 713.661.4383
Cosmetic 832.553.2314
6565 West Loop South #800 – Bellaire, TX 77401