What is Mohs Surgery?

Mohs micrographic surgery is the gold standard of treatment for many basal cell and squamous cell skin cancers, especially those located in areas where it is vital to spare as much normal skin and tissue as possible.

Dr. Saira Momin is fellowship-trained in Mohs micrographic surgery. In addition to medical school and dermatology residency, this surgery-specific training specially qualifies her to:

• surgically remove skin cancer

• evaluate the pathology of the skin cancer in her on-site lab

• close or reconstruct the wound

What are the advantages of Mohs surgery?

When skin cancer is on a cosmetically or functionally sensitive area – such as the face, ears, scalp, fingers, toes or genitals – Mohs surgery offers the best cosmetic and functional outcome. Mohs surgery is also recommended for non-melanoma skin cancers that are large, aggressive or growing rapidly, or that are recurring after treatment.

Advantages of Mohs surgery include:

• 99 percent cure rate for cancer that hasn’t been previously treated

• Tissue-sparing which leaves the smallest scar possible, offering you the very best cosmetic and functional outcome.

• Significant cost-savings to patients. Patients pay for an outpatient visit, local anesthesia and lab work done on-site, saving them hundreds of dollars in facility fees.

Since Dr. Momin is trained to examine the pathology of your skin cancer on-site as she performs the surgery, you will be able to walk away from Dermatology Surgery Specialists with the confidence that your surgical site is skin cancer-free.

How is Mohs surgery performed?

Mohs surgery is performed in stages, all in one visit, while you wait in our comfortable waiting room. After Dr. Momin removes a layer of tissue, she examines it under a microscope in her on-site lab. If any cancer cells remain, Dr. Momin knows exactly where they are located, and she removes another layer of tissue from that precise area, while sparing as much tissue as possible. She repeats this process until no cancer cells remain.

Mohs Surgery Step-by-Step

• After confirming the biopsy site with you, Dr. Momin will mark the diagnosed site with a surgical marker. She then positions you and injects local anesthesia to numb the area completely. You will stay awake throughout the entire procedure.

• Using a scalpel blade, Dr. Momin removes a thin margin of skin visible around cancerous tissue where the biopsy was taken. This may be ‘the tip of the iceberg’ meaning that some skin cancers have roots or extensions that aren’t visible from the surface. Your wound will be temporarily bandaged, and you can relax and wait while the tissue is being processed.

• In the lab, Dr. Momin draws a map of the tissue, cuts it and dyes the sections. Then, a technician freezes the divided tissue and cuts it into very thin layers. The slices are placed on microscope slides, stained and cover-slipped. This meticulous process takes some time, but we ensure that you’re comfortable while you wait!

• Using a microscope, Dr. Momin examines the entire skin edge and base of the tissue, and if any skin cancer cells remain, she marks them on her map. She will then let you know if your surgical site is cancer-free or if she needs to take another layer of tissue.

• If more surgery is needed, you’ll head back to the operating room with Dr. Momin, where she injects additional anesthesia and takes another thin margin of skin, precisely where the skin cancer cells remain based upon her map. This process is repeated as many times as needed until there are no remaining skin cancer cells.

• Once your surgical site is clear of cancer cells, Dr. Momin may leave your wound open to heal or she may close the wound with stitches. This depends on the size and location of the wound. In some cases, closing the wound may require a skin flap or skin graft. In other cases, Dr. Momin may coordinate the repair of your wound with another specialist such as a plastic surgeon, oculoplastic surgeon or hand surgeon.

• If several rounds of surgery are needed, this process may take several hours, so we want you to be prepared. The payoff for your time spent is that this technique has the highest cure rate for skin cancer and leaves the smallest scar!