Mohs micrographic surgery (also known as Mohs chemosurgery) is a surgical technique in which very thin layers of skin tissue are meticulously removed, stained, and examined under a microscope.
It is named after dermatologist Frederick E. Mohs, who developed the technique in the first half of the 20th century. By removing layers of tissue in such an incremental manner, the physician can be sure that all tumor tissue is excised, and can simultaneously spare normal tissue. Of all the surgical techniques available today, Mohs surgery offers both the lowest recurrence rate for malignant lesions and the maximum potential for preservation of healthy tissue. Mohs surgery is performed by specialized Dermatologic Surgeons who limit their practice to treating skin cancer patients and performing skin cancer removal. Frequently, the Mohs surgeon will then refer patients for reconstruction to a Facial Plastic Surgeon such as Dr. Ransom. This helps to ensure the best possible outcome, both in terms of cancer care and cosmetic appearance – especially in highly visible and functional areas, such as the face.
Mohs surgery is more time consuming and expensive than traditional removal (sometimes called “wide local excision”). However, its precision is especially valuable for recurrent or aggressive carcinomas, for treatment of cosmetically important areas such as the nose, eyelids, lips, or chin, and for high risk and invasive lesions (such as those near branches of the facial nerve or other nerves). Mohs surgery is now frequently used to remove basal cell carcinomas (BCC), squamous cell carcinomas (SCC), some melanomas, and selected other lesions on the face.
After a malignant lesion is removed with Mohs surgery, a depression or hole in the skin remains (the surgical defect). Such scars may be rather disfiguring, but reconstructive surgery may be performed immediately after Mohs surgery to repair the damaged site. Dr. Ransom specializes in carefully reconstructing the facial tissues in such patients, restoring the natural appearance of the facial contours and the delicate skin of the head and neck, and preserving the crucial functions of the facial structures (such as the nose, eyelids, or lips).
Some of these repairs require multiple stages and thus expertise in local and regional flap reconstruction. Dr. Ransom has extensive training in complex and multi-stage Mohs reconstruction. These procedures can be performed with local anesthetic in nearly all cases, making the process easier for the patient and helping to promote a faster recovery. Please visit the photo gallery for some examples.
Who is a candidate?
Patients with a skin cancer of the Basal Cell (BCC) or Squamous Cell (SCC) variety in a sensitive location such as the face are candidates for Mohs surgery. Mohs reconstruction (repair of a defect from Mohs surgery) may be performed by your dermatologic surgeon in many cases. However, referral to a facial plastic surgeon such as Dr. Ransom is often made in cases where the defect is large, in a complex 3-dimensional area (e.g., the nose or lips), or requires multiple stages with flaps and grafts. Dr. Ransom receives Mohs reconstruction referrals from multiple dermatologists in San Francisco and Marin County.
Frequently Asked Questions
Q: If I want Dr. Ransom to perform my Mohs reconstruction, how can I set this up?
A: First, you can discuss your preference for plastic surgery closure with your Mohs surgeon. Then you can call our office to coordinate the timing of the cancer removal and the repair. Next, either you or your dermatologist can fax our office the information about your skin cancer history. We will then work with you and your referring physician to create a comprehensive plan.
Q: Does insurance cover the cost of Mohs reconstruction?
A: Yes, all insurance plans, including Medicare, cover the costs associated with Mohs reconstruction. Depending on the specifics of your plan, you may still have out of pocket costs associated with your deductible, copays, etc. Dr. Ransom accepts all major PPO plans and is contracted with Medicare for these procedures.
Q: What type of anesthesia is used for Mohs surgery repairs?
A: In the overwhelming majority of cases, local anesthesia is used and the surgery is performed in the office. For very large defects of the face, nose, or scalp, some patients may require sedation in addition to local anesthesia. This can be arranged at our surgery center in the building or at a hospital in San Francisco or Marin County.
Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.