Mohs surgery — originally developed in the 1930s by Frederic E. Mohs, MD — has been refined into the most advanced, precise, and effective treatment for an increasing variety of skin cancer types.
With the Mohs technique, it is possible to precisely identify and remove an entire tumor while leaving the surrounding healthy tissue intact and unharmed.
While treatment of the skin cancer is a patient's primary concern, reconstruction of the treated area is also important. Once all of the cancer has been removed, surgeon and patient determine together if a reconstruction procedure is needed and what kind of procedure to use.
The surgeon may be able to tell whether the reconstruction should take place immediately after surgery or be delayed until later.
There are several options for post-Mohs reconstructive surgery available today. They vary because the locations, amounts, and types of tissues affected differ from person to person. The size of the tumor and depth of its roots are factors.
Here, Tara L. Huston, MD, a member of our Plastic and Reconstructive Surgery Division and leader of the Melanoma Management Team of the Stony Brook Cancer Center, answers frequently asked questions about post-Mohs reconstructive surgery after skin cancer.
Q: What exactly is Mohs surgery?
A: Mohs surgery is the most precise way to remove a basal or squamous cell skin cancer. The dermatologic surgeon cuts out (excises) the cancer layer by layer, looking at the tissue that is removed under the microscope until the absence of all cancer cells is confirmed.
Mohs surgery offers the highest potential for cure, even if the skin cancer has been previously treated by another method.
Basal and squamous cell skin cancer — the two most common kinds of skin cancer — occur on the outer layer of the skin. They are most often found in areas exposed to the sun, such as the head, neck, and arms, but they also can occur elsewhere.
In recent years, Mohs surgery is being increasingly used as an alternative to standard excision for certain melanomas. However, not all doctors agree on using Mohs for melanoma, which is the most dangerous form of skin cancer and can penetrate the skin deeply.
Our specially-trained Mohs surgeons have a state-of-the-art unit
designed especially for Mohs surgery, with all the latest technology needed for it.
Q: Why is Mohs surgery so effective in treating skin cancer?
A: With the Mohs technique, as compared to traditional surgical removal of skin cancer, more of the specimen is able to be evaluated under the microscope. This is the best way to ensure that all of the cancer cells have been removed. The effectiveness of Mohs is near 99%, while traditional surgical removal is slightly lower.
Q: What areas of the body are treatable by Mohs surgery?
A: As Mohs is a tissue-preserving technique, it is most commonly used on areas that are of high functional and aesthetic importance such as the head, neck, hands, feet, and anogenital region.
Q: What is reconstruction following Mohs surgery?
A: The goal of reconstruction following Mohs surgery is to restore form and function to the areas which were treated for skin cancer. For this part, the dermatologic surgeons will often work in concert with plastic surgeons.
Q: What are the options for reconstruction after Mohs surgery?
A: The options for reconstruction depend on the anatomic location, depth, and extent of the Mohs defect. Reconstruction can be as simple as guiding wound healing and allowing the area to contract on its own.
Sometimes the defects can be closed in a straight line. Other times a skin graft is used (from near the ear or clavicle) or the local tissue is rearranged.
In rare instances, free-tissue transfer (from a distant part of the body) is done. Our surgeons are skilled in this technique as well. The plastic surgeon will attempt to hide the scars along existing facial creases and natural landmarks for the most aesthetic result.
Q: When is reconstruction done after Mohs surgery?
A: Reconstruction is most commonly performed the same day or the day following the Mohs procedure.
Our plastic surgeons are highly skilled at performing the full range of
post-Mohs reconstructive procedures, and they work closely with our Mohs surgeons.
Q: How are the different reconstructive procedures done?
A: The great majority of the procedures discussed here are performed in the plastic surgeon's office under local anesthesia. Only a small handful of the cases that we do here at Stony Brook Medicine require a trip to the operating room. This can either be for patient comfort or to close a very large defect.
Q: What is the recovery time for each of these procedures?
A: With most of these reconstructive procedures, the downtime is minimal. Most patients are able to be back to their normal activities by the following day wearing just a band aid. In most cases, over the counter acetaminophen (Tylenol) is sufficient to control the associated discomfort.
Q: Is post-Mohs reconstructive surgery considered cosmetic or medically necessary?
A: When referred by the dermatologic surgeon for post-Mohs reconstruction, most insurance companies consider it medically necessary and do cover the cost of the procedures.
Q: What is the advantage of having post-Mohs reconstructive surgery done at Stony Brook Medicine?
A: Stony Brook Medicine provides comprehensive, multidisciplinary care to patients with skin cancer. We offer screening, surgery, and the option to participate in clinical trials. The availability of clinical trials serves as a hallmark of our ability to offer leading-edge treatment.
Our specially-trained Mohs surgeons have a state-of-the-art unit designed especially for doing Mohs surgery, with all the latest technology needed for it.
Our plastic surgeons are highly skilled at performing the full range of post-Mohs reconstructive procedures, and they work closely with our Mohs surgeons.
Our dedicated team of dermatologists, dermatopathologists, surgeons, medical oncologists, and radiation oncologists meets frequently to review cases, and thus we ensure our patients receive all the benefits of multidisciplinary care.
|FREE Skin Cancer Screening and Melanoma Educational Program provided by Stony Brook Medicine Dermatologists and Melanoma Team:
When: Saturday, May 11, 8 to 11:30 am.
Where: 23 South Howell Avenue, Suite G, Centereach, NY 11720 (map/directions).
Are you 18 or older? Was your last skin cancer screening by a dermatologist more than a year ago? If so, call 631-444-4000 for an appointment.