A Sophisticated Skin Cancer Treatment for Marco Island and Naples, FL
While the dermatologists at Skin Wellness Physicians perform Mohs surgery in Naples, FL, the technique was first developed by the late Dr. Frederich Mohs in Wisconsin. Frustrated by the frequent rate of recurrence for many skin cancers removed by standard surgical techniques or other procedures (such as radiation or electrodessication and curettage), he set out to develop a new way of both removing and processing the tissue in order to provide maximum precision and margin control.
Mohs surgery is defined only by times when the surgeon acts as both the surgeon and the pathologist. It is also the sole technique where the entire surgical margin is evaluated. Because of this, it has the highest cure rate—95 to 99 percent—of all skin cancer treatments.
How Does Mohs Surgery Compare to Other Surgical Techniques?
Standard excisions, or surgical removal of tissue by means other than Mohs surgery, will often involve a technique as imprecise as slicing bread. Imagine a loaf with raisins in it. If we took a slice or two of the bread to see what was inside, we could, by chance, miss the raisins entirely and mistakenly consider the bread to be plain.
Now, let's translate that analogy to medical dermatology, where the consequences for missing cancer cells due to an imprecise technique are far more significant. Basically, checking the margins on a skin cancer sample that has been removed by a standard excision technique—not Mohs surgery—can actually evaluate less than 5 percent of the total margins. Some people have put that number as less than 1 percent!
Depending on the location, size, and type of skin cancer, this may not be good enough. Fortunately, Mohs surgery offers 100 percent margin control. As a result of our ability to evaluate the totality of the surgical margins, we are able to excise less skin, making the procedure much more conservative in nature. If, after evaluating the surgical specimen slides, the physician discovers that there are still some areas where a tumor remains, the physician will map it out with accuracy down to a hair follicle, allowing for the removal of a small amount of additional tissue. This process repeats itself until the tumor is completely removed, no cancer cells are visible in any margins, and the wound is ready for suturing.
When is Mohs Surgery Used?
Mohs surgery is reserved for special circumstances due to the increased level of care that comes with this procedure. Certain criteria are used to determine which skin cancers would most benefit from the technique. The location (i.e. head, neck, hands/feet, genitals, shins), size, and type of skin cancer, are the most common variables weighed along with some extenuating circumstances. Doctors may also consider a patient's age, immunosuppression, certain genetic syndromes, the presence of recurrent skin cancer, and whether skin cancer was caused by radiation.
Who Performs Mohs Surgery in Naples, FL?
At Skin Wellness Physicians, we employ and only endorse fellowship-trained Mohs surgeons who are recognized by the American College of Mohs Surgery. Other organizations, such as the American Society of Mohs Surgery, offer abbreviated courses to certify in Mohs surgery.
The American College of Mohs Surgery requires at least a year-long fellowship strictly dedicated to Mohs surgery training and building expertise in reconstruction techniques necessary for repairing the surgical defect left behind following removal of skin cancer. A large number of complex cases during the fellowship are required in order for a physician to receive certification and membership into the American College of Mohs Surgery.
Note that all of the clinical trials performed exemplifying the superior cure rates of Mohs Surgery (95 to 99 percent) for skin cancer above all other skin cancer treatments were done exclusively by fellowship-trained Mohs surgeons. In order to ensure the highest quality of skin cancer surgical care, we strongly recommend that you have a Mohs College member perform your Mohs surgery.
Mohs Surgery Frequently Asked Questions
We recommend you bring a sweater or jacket, because our office is often kept at cooler temperatures.
A friend or family member for support is a good idea. If you are having surgery near the eye, on your hand, or on your nose, you may want to consider having someone be a driver for you because the post-operative bandage may interfere with your ability to drive home. If you require a driver, but are unable to have a friend or family member drive you, your local American Cancer Society chapter will often have volunteer drivers available for patients requiring cancer treatments.
Our medical team will process your arrival. After our clinical staff brings you in, you will be given time to ask any additional questions so that you can make a comfortable, informed consent prior to beginning the Mohs surgery. The surgeon will then enter the room and mark the area to be removed. After confirming the site with you, the surgeon will notify the clinical staff to gently anesthetize it. Once the area has been numbed, the surgeon will return to the room to perform the Mohs surgery. Following each stage of the procedure (which takes 45 to 60 minutes total), you will be bandaged and escorted back to the waiting room while your tissue is processed. Coffee, drinks, and refreshments will be available for you in our waiting area.
Please expect and plan to be here all day. Oftentimes, two to four hours can be expected, though Mohs Surgery is frequently unpredictable and the surgeon often requires a substantial amount of time to remove the skin cancer. There are many factors that can lead to a prolonged surgery day, including challenges processing the tissue, large tumors that require more time for processing or multiple stages for complete removal, or individual patient needs.
At this point, the clinical staff will bring you back to the procedure room and prepare you for wound closure. More than 90 percent of the time, a straight line will be used for closure after Mohs surgery.
Occasionally, a flap or tissue rearrangement will be required. This will result in a more geometric arrangement of suture lines that may better hide them in creases or folds, depending on where the tumor was located or how large the tumor was.
A skin graft may be used in rare occasions when other techniques are not applicable.
Lastly, we may allow for the wound to heal in on its own, letting Mother Nature do the job. Less than 1 percent of the time we may need to collaborate with another surgical specialist to provide tertiary surgical services. This is something that would be discussed with you at your Mohs surgery visit or consult.
Depending on the location and extent of your Mohs surgery, we will likely recommend some wound care for you to do at home once you remove the bandage. Some useful supplies to have on hand are:
- hydrogen peroxide
- white vinegar (the cheapest store brand available is just fine)
- non-stick gauze pads
- a clean container of Vaseline or white petrolatum
- paper tape
- Tylenol for pain (we try to avoid ibuprofen because it can add to some post-operative bleeding)
- waterproof bandages (if you swim frequently)
- NOTE: DO NOT USE ANTIBIOTIC OINTMENTS BECAUSE OF THEIR FREQUENT CAUSE OF ALLERGIC SKIN REACTIONS
Additional instructions will be provided to you by the clinical staff prior to your discharge from the office.
We commonly prescribe antibiotics prior to Mohs surgery or after surgery depending on the location, type of repair, or other extenuating circumstances. Pain pills may be prescribed depending on whether the physician feels the post-operative pain will be inadequately controlled by over-the-counter Tylenol. Patients require prescription narcotics for post-operative pain control less than 5 percent of the time.