Mohs Surgery at Tareen Dermatology

Mohs surgery is a specialized type of surgery developed by Dr. Frederic Mohs in the early 1940s. Dr. Mohs recognized that a skin cancer often resembles a “tip of the iceberg” with more skin cancer cells growing downward and outward into the skin, like the roots of a tree. These “roots” are not visible with the naked eye, but can be seen under a microscope. Mohs Micrographic Surgery is a highly specialized and precise treatment for skin cancer in which the cancer is removed in stages, one tissue layer at a time. It is an outpatient procedure. This insures the highest rate of cure with the smallest amount of tissue removed. Dr. Mohiba Tareen, who completed a year-long procedural dermatology fellowship AFTER her 3 year dermatology residency at Columbia University, has specialized training in Mohs surgery.

How does Mohs surgery work?

Once a tissue layer is removed, the edges are marked with specially colored dyes, and a map of the specimen is created. The tissue is then processed and carefully examined under the microscope so that any microscopic roots of the cancer can be precisely identified and mapped. When cancer cells are seen, an additional tissue layer is removed only in areas where the cancer is still present, leaving normal skin intact. This saves as much normal, healthy skin as possible. Once the cancer has been removed, the Mohs surgeon will explain options for repair of the wound, including natural healing (granulation), stitching the wound together by a side to side closure, or using a skin flap or graft. For very deep or large tumors that may require repair in the operating room, the patient may be referred to a plastic surgeon.

In what cases is Mohs surgery recommended?

Not all skin cancer requires Mohs surgery. Criteria for Mohs are stringent and include the following:

• The skin cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, other critical facial areas, as well as fingers, toes and genitals
• The skin cancer was treated previously and has come back
• Scar tissue exists in the area of the skin cancer
• The skin cancer is large
• The edges of the skin cancer cannot be clearly defined
• The skin cancer is growing rapidly or uncontrollably
• The skin cancer is of an aggressive subtype

The biopsy seemed to have removed all of my skin cancer – I do not see anything anymore. Do I still need Mohs surgery?

Following a biopsy, a skin cancer may no longer be visible. However, the surface lesion that was removed can represent the “tip of an iceberg.” More tumor cells may remain in the skin. These can continue to grow downward and outward, like roots of a tree. These “roots” are not visible with the naked eye. If they are not removed, the tumor will likely reappear and require more extensive surgery. Tumors that are neglected can spread deeply into the skin and invade nearby structures. On rare occasions, these cancerous cells can metastasize and spread to lymph nodes and other organs in the body.

What do I need to do to prepare for my Mohs surgery?

Our head nurse will call you prior to the surgery to review any questions. She will offer you the option of pain medication and potentially an oral antibiotic (based upon the type of procedure). On the morning of the procedure, please eat a good breakfast. Mohs is potentially a full day long procedure so please do not schedule any important appointments that day. In order to optimize the cosmetic outcome and limit waiting time, Dr. Tareen often performs the skin repair the next day. This will be discussed with you prior to the procedure.

Will there be a scar from my Mohs surgery?

Any treatment for skin cancer will leave a scar. However, Mohs surgery minimizes the amount of skin that is removed in order to optimize the final cosmetic outcome. Most post-surgical scars improve with time and can take up to one year to fully mature. As your surgical site heals, new blood vessels can appear and support the healing changes occurring underneath the skin. This can result in the temporary reddish appearance of the scar, which will resolve with time. Dr. Tareen sees her patients in close follow-up in order to optimize the cosmetic outcome of all surgeries.