Mohs micrographic surgery is actually named after the person who invented it.
And, I always get the question: "well what does it stand for?" and "what is it an
acronym for?" and it's not. It's named after Dr. Fred Mohs, who pioneered this
technique in the 1940's.
And so, what the procedure is like is an individual comes
in to see me for a skin cancer somewhere on the head and neck.
I remove, I anesthetize the patient, I remove what I can see with my eyes.
So, only the visible spot of the biopsy or the skin cancer gets removed.
I don't take any margin around there.
And, the reason I don't have to take a margin is because in
20 minutes, I'm looking under the microscope at your tissue.
And so, you go from walking into my office
typically about thirty minutes later,
I'm looking under the microscope at your skin
and I can see every single root and trace.
And, if there is any part of that skin cancer
that has spread beyond what I have taken
I'll see that under the microscope.
And the benefit to the patient is
that, not only am I the surgeon, I'm also the pathologist.
So you have that continuity
where I make a map and I know exactly where that cancer is.
So, once I look under the microscope
and I see one portion of tumor there, then I go back to
the patient and I take a little bit more but only where I have to.
Leaving behind all of that normal skin
which when we're talking about the tip of the nose, that's crucial.
A millimeter or two here and there is very important.
Whereas on the on the arm or the leg maybe it's not as necessary.
It's sort of that old real-estate adage
location, location, location.
And so, when you're talking about the prime
real estate locations, this is the procedure you want.
And so, the patient and I go back and forth
and back and forth,
hopefully not too many times,
until I achieve, under the microscope, what I'm looking for
which is clear margins.
Once I've determined the margins are clear, then I return to the patient.
We examine the surgical defect together and then we decide what's the
best course of action. And, usually it ends up being
stitches in my office, usually a straightforward reconstruction.
Other times, we have to get a little bit more creative
in terms of closing that hole, but it typically involves
some kind of stitch work that we do right then and
there, in the office, after the cancers been removed.
And then, I usually will see the patient back
about a week or so after the surgery to remove the stitches.
Once you've had a skin cancer, research statistics have shown that you
are at higher risk for the development of more.
Not necessarily at that same place
because once you've had the surgery your cure rates are about
99 percent, but rather you are at higher risk for developing new spots on
another ear, or a cheek, or a knee.
And so, it's very important for you to follow up with
your dermatologist, whether that's me or whether that's another dermatologist
that sent you to me. It's very important to keep close regular follow-up and
usually that's at least once a year and in some cases it's every four months,
every six months, until your dermatologist or myself have put
you back in a low-risk category.
Most important part of what I do and I would
say my top priority is removing cancer. It doesn't do you any good if
I do a gorgeous reconstruction and you can't even see the scar, it doesn't do
you any good if I leave cancer behind.
So, first and foremost, I'm a cancer surgeon
and my number one goal is to remove skin cancer.
But, a very close second, a very,
very, very, close second behind that, is to make you look as good as I possibly can.
Is to make you look like you did an hour before coming in to see me
when I had to make make a big hole in you.
And so, I take that job just as seriously as
I take my first job, which is to rid you of cancer.
And, fortunately we have multiple different creative ways
to put someone back together after we've had to
make a hole for the skin cancer. We have lots of different tips and we have
lots of different tricks up our sleeve to
make someone look as good as we as we possibly can.