Dr. Karen Nern preforms Mohs micrographic surgery which is a safe and effective treatment for skin cancer. During Mohs surgery, cancerous tissue is removed in small sections. While the patient waits, Dr. Nern examines each tissue specimen for malignant cells. If malignant cells are found, more tissue is removed until the cancer is eradicated. This comprehensive microscopic examination helps to target only cancerous tissue, significantly reducing damage to healthy surrounding tissue. Developed by Frederic E. Mohs, M.D., in the 1930s, Mohs surgery excises not only the visible tumor, but any "roots" extending beneath the surface of the skin. Five-year cure rates of up to 99 percent for first-time cancers and 95 percent for recurring cancers have been documented.
Mohs surgery is primarily used to treat basal and squamous cell carcinomas, the two most common types of skin cancer, although it can be used for melanoma and other types of cancer. Mohs surgery is often recommended for recurring cancers, as well as those in difficult-to-treat areas, such as the nose, eyelids, lips, hairline, hands, feet and genitals, in which preserving as much tissue as possible is extremely important.
The Mohs Surgery Procedure
Dr. Karen Nern and her team of highly trained specialists, preform Mohs surgery as an outpatient procedure in our Edwards and Basalt office. During Mohs surgery, the treatment area is numbed with a local anesthetic. Small layers of skin are removed, and each layer is examined microscopically by Dr. Nern to see if it contains malignant cells. Excision continues until the cancer is completely removed. Most Mohs procedures can be performed in three or fewer stages, and take approximately 4 hours. Dr. Nern is a fellow of American Society for Mohs Surgery and has preformed over 3,000 Mohs procedures in our Edwards and Basalt locations.
Recovery from Mohs Surgery
After Mohs surgery, patients experience mild discomfort, bleeding, bruising and swelling. Pain medication is prescribed if needed, although most patients require only over-the-counter medication.
Mohs surgery leaves scars, although they are often smaller than those from other excision procedures. Reconstructive procedures, including skin flaps and skin grafts, can reduce the prominence of, or even eliminate, scars; they can be performed at the same time as the Mohs surgery or at a later date. If possible, surgical techniques, including placing stitches in the skin's natural creases or out-of-sight areas, are used to make scarring less visible.
What Are the Advantages of Mohs Surgery?
The most significant advantage to Mohs surgery is its extremely high success rate. Studies have shown that primary basal cell carcinoma removal has a 97-99% cure rate, while squamous cell carcinoma is considered to be successful approximately 94% of the time. Melanoma-in-situ removal success ranges from 75-95%, depending heavily on the skill of the surgeon.
Will I Experience Significant Scarring from this Surgery?
All surgical procedures carry the risk of scarring, and Mohs surgery is no different. However, the dermatologist performing Mohs surgery can utilize multiple methods to further prevent visible scarring to the affected area, including:
- Integrate stitching into natural skin crevices
- Affixing a skin graft procured from a less visible part of the body
- Shifting the skin with a "skin-flap"
- Allowing a specialized plastic/reconstructive surgeon perform the closure
Also important to note is that the size and location of the tumor heavily influence scarring potential. The procedure itself is designed to minimize tissue excised due to the small surgical margin of 1 millimeter, therefore naturally leading to less scarring.