moh’s Micrographic Surgery

Indications for Mohs micrographic surgery:

• Primarily for basal and squamous cell carcinomas, occasionally for melanoma
• Especially for previously treated skin cancers that recurred
• Scar tissue present in the area of the skin cancer
• Preservation of healthy tissue is essential:  eyelids, nose, ears, lips
• The skin cancer is large
• The edges of the skin cancer are undefined

Moh’s Surgery Summary

• State-of-the-art skin cancer treatment
• Dr. Cohen is the excising surgeon, pathologist and reconstructive surgeon
• In office, single day procedure
• Chase skin cancer down to its roots using the microscope
• Most exact and precise means of removal
• Cure rate up to 99%
• Has the lowest chance of  cancer re-growth in that area
• Minimizes the potential for scarring or disfigurement by leaving healthy tissue unharmed

Your doctor has identified a skin cancer during your examination.  This is likely a Basal Cell Carcinoma or Squamous Cell Carcinoma and referred you to Dr. Cohen for a specialized type of skin cancer surgery called Mohs Micrographic Surgery.  With this specialized technique, explained below, there is up to a 99% cure rate… even if other treatments have failed.  One in five American’s will develop a skin cancer, your doctor made a smart decision by referring you here.

Just to clarify, we are talking about “Mohs Surgery” here, not MOLES surgery, although they do sound very similar.  If you would like to read more about the history of how this ingenious life-saving technique was developed by dermatologist Dr. Frederic E. Mohs in the 1930’s we welcome to visit the Mohs College Website at www.Mohscollege.org.

Mohs Micrographic Surgery, is an advanced treatment procedure for skin cancer, that offers the highest potential for recovery and cure—even if the skin cancer has been previously treated. This procedure is a state-of-the-art treatment in which the physician serves as excisional surgeon, pathologist and reconstructive surgeon. It relies on the accuracy of a microscope to trace and ensure removal of skin cancer down to its roots. This procedure allows dermatologists, trained in Mohs Surgery, to see beyond the visible disease, and to precisely identify and remove the entire tumor, leaving healthy tissue unharmed. This procedure is most often used in treating two of the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma.

Dr. Cohen is one of only a handful of full fellowship trained Mohs surgeons in the State of Colorado.  He trained through the official American College of Mohs Micrographic Surgery and Cutaneous Oncology at the University of British Columbia.  While other doctors spend only a few days learning this technique, Dr. Cohen spent over one year in a fellowship perfecting this technique under the supervision of some of the world leaders in this field.  During his training, he performed well over his minimal requirement of 500 cases.  In addition, his wealth of surgical experience was broad, and also included plastic surgical rotations.  He continues to perform over 450 Mohs surgery cases a year, and has been appointed to a leadership role in the Mohs College on the Public Affairs Committee.  He has also be invited to lecture twice at the prestigious International Skin Cancer Foundation meeting on the subject of Mohs Micrographic Surgery.

A simple overview of the Mohs technique follows, for a more detailed description with informative drawings please visit www.Mohscollege.org.

During your Mohs surgery, Dr. Cohen starts by removing the visible tumor with a curette or scalpel.  He then proceeds to remove very thin layers of the surrounding skin one layer at a time. Each layer is checked thoroughly under a microscope, and the procedure is repeated until the last layer viewed is cancer-free. Local anesthesia (injection of lidocaine at the surgical site) is all that is required to perform this procedure.  This technique not only has the highest cure rate, but also is tissue sparing so that it saves the greatest amount of healthy skin.  Following complete tumor removal, the area is reconstructed depending on the type of defect left by the removal process.  Reconstruction is individualized to achieve the best results for you, taking into consideration both functional and aesthetic principles.  This can vary from simple linear closure, to graft, flap, or left open to heal by itself.  Occasionally if the wound is larger or in a certain area, another surgical specialist with unique skills may complete the reconstruction.  Dr. Cohen frequently works with specialists from Oculoplastic Surgery, ENT and Facial Plastics if the need arises.

Mohs surgery is frequently used for tumors on the head or neck or those that have recurred or are in hard-to-treat places such as the hands and feet. This entire procedure is done usually over the course of several hours as outpatient surgery at our AboutSkin Dermatology clinic on the Swedish Hospital campus.

When you schedule your pre-operative visit with us, Dr. Cohen will review with you the importance of strictly following the pre-operative instructions to ensure your surgical day runs as smoothly as possible.  He will also discuss the specifics of the surgical day that are tailored specifically to eradicate your skin cancer.

Dr. Cohen often performs this surgery on patients referred by fellow local and regional dermatologists.  He is acting as a surgical consultant in this manor and maintains a correspondence with your general dermatologist to keep them informed of how the process of your tumor removal is going.  He sends a letter to your doctor detailing the specifics of the surgery so your files at your dermatologist are complete.

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