Skin Cancer & Mohs Surgery

Mohs Surgery & Reconstruction

The Woodruff Institute, located in Naples, Bonita Springs & Estero, Florida offers Southwest Florida patients the benefits of fellowship trained Mohs Surgeons and a board certified Facial Plastic and Reconstructive Surgeon under one roof.

Our patients receive the precision of a Mohs Surgeon and the aesthetic expertise of a Facial Plastic Surgeon for the treatment of their skin cancers.

If you have had skin cancer and are not familiar with the Mohs surgery technique, please take a moment to read this page. Mohs micrographic surgery, an advanced treatment for skin cancer, offers the highest potential for complete eradication or cure – even if the skin cancer has been previously treated. Mohs surgery is used to treat two of the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma. Often skin tumors have a subtle appearance, with the visible portion representing only a small part of a larger, deeper tumor. Using a microscope, our Mohs surgeons are able to trace out and remove the skin cancer. Doing so, our Mohs surgeons are able to see beyond the visible disease, and to precisely indentify and remove the entire tumor, leaving healthy tissue intact and unharmed. Our physicians have been performing Mohs surgery and Mohs reconstruction in Southwest Florida since 2004. Click here to read our blog, “A Patient’s Guide to Mohs Surgery.”

History
Developed by Frederic E. Mohs, M.D., in the 1930s, the Mohs micrographic surgical procedure has been refined and perfected for more than a half a century. A procedure that once took several days to complete is now performed in a few hours.

Common Skin Cancer Treatments
Skin cancers that are detected early can often be treated by curettage and electrodesiccation, cryotherapy, surgical excision, or radiation. However, if the tumor is in a cosmetically sensitive area, has been previously treated, is large, is not clearly defined, or arises in a scar, Mohs surgery offers the highest potential for complete removal of the cancer, while sparing the surrounding healthy tissue. Mohs surgery has superior cure rates to surgical excision with frozen sections. In Mohs surgery, the tissue is processed so that every cell along the margins is examined. With traditional frozen sections only a few samples of the whole specimen are examined, with the hope that the samples represent the entire tumor.

Procedure
Mohs surgery is performed in the office under local anesthesia. As the procedure will take several hours to complete, we recommend that you eat before your procedure, bring a snack, bring reading material, and bring a friend or family member. Although you will be physically able to drive yourself home, you may be tired and have some swelling.

After a local anesthetic is injected into the area, the visible tumor is removed with a scalpel. A dressing is applied to the wound and the patient returns to the waiting room. Meanwhile, the first stage of tissue is taken to the laboratory (located in the office), where the tissue is processed and microscopic slides are prepared. The Mohs Surgeon reads the slides with the aid of a microscope and prepares a map of any remaining tumor.

If there is tumor present, the patient returns to the room, additional local anesthesia is administered, and another layer of tissue is removed (only in the areas where tumor remains). This second stage of tissue is brought to the laboratory where the process is repeated until the cancer has been completely removed.

Reconstruction
The best method of managing the wound resulting from surgery is determined after the cancer is completely removed. Management of the surgical site is individualized to achieve the best results, preserving functional capabilities and maximizing aesthetics. A small wound may be allowed to heal on its own. Alternatively, the wound may be closed with stitches, a skin graft or flap. Dr. Daniela Burchhardt, the Woodruff Institute’s Facial Plastic Surgeon, is available on site to perform your reconstruction, if you desire.

The Mohs Surgeon
A Mohs surgeon is a specially trained dermatologist who removes skin cancers and is also speically trained as a pathologist and reconstructive surgeon. The American College of Mohs Micrographic Surgery and Cutaneous Oncology (Mohs College) (www.mohscollege.org) is the oldest professional organization of physicians trained in Mohs micrographic surgery. To be accepted as a member of the Mohs College, a physician must complete a three-year residency in dermatology or a related field, plus a one- or two-year fellowship approved by the Mohs College that includes extensive training in pathology and reconstructive surgery. Physicians who have completed a Mohs College approved fellowship will, by virtue of their rigorous training, possess the skills and expertise necessary to perform Mohs microgaphic surgery at all levels of complexity.

Digital Flipbook for Patients Now Available

Before and After Mohs Surgery: What to Expect for Patients is a digital flipbook to inform patients on common postoperative healing scenarios such as normal inflammation around an incision, spitting suture, flap pin-cushioning, pigmentary changes, and much more. It also provides a brief explanation of the unique expertise and value of having a fellowship-trained Mohs surgeon.

Use your camera phone to scan the QR code or click the image below to view

Frequently Asked Questions About Mohs Surgery

What is Mohs?

Mohs is named for Frederick Mohs, MD, who invented the procedure. It is a surgical procedure designed to remove a skin cancer completely, yet leaving as much normal tissue behind as possible. After the tumor is removed, the tissue is examined under a microscope to see if any tumor remains. A map created with the aid of a microscope will tell the surgeon exactly if and where the margins are positive for tumor. Subsequent stages are taken until the tumor is completely removed.

Do I need to stop aspirin, Coumadin, Plavix, or other blood thinners?

No. Studies have shown that there are more complications associated with stopping blood thinners than there are from staying on them for minor skin procedures. If you take aspirin, ibuprofen or other NSAIDs as needed for pain, we recommend that you avoid them if possible for two weeks prior to surgery.

Am I able to drive myself to and from the surgery?

Yes. Although it is nice to have company on the day of surgery, it is not required. Only local anesthesia is used, so you will not be impaired in any way.

How long does the surgery take?

This is a difficult question to answer as it depends on how many stages of Mohs are required to clear the tumor. Plan on being here for several hours and if you are finished early it will be a pleasant surprise. Please do not make other important appointments for the day of the surgery.

What should I bring with me on the day of surgery?

Bring a book or some activity to keep yourself occupied during the time that your specimen is being processed. Bring a sweater or jacket as some times our office can be a little cool. Bring a friend or family member if you would like company.

What supplies do I need for wound care following surgery?

This is also not an easy question to answer as it depends on how the wound is repaired. Following your surgery we will give you written wound care instructions including what supplies you will need. We can also give you a few days worth of supplies to last you until you are able to visit the pharmacy.

Will I need pain medication following surgery?

We offer all of our patients pain medicine following surgery. Many find that they do not require pain medicine. If you do take pain medicine, you should not drive or do other activities that require mental acuity.

Will I have a scar?

Any time a cut is made in the skin there will be a scar or mark. Our goal is to make this scar as imperceptible as possible. We will continue to work with you, long after your surgery if necessary, to minimize your scarring. Mohs Surgery Patient Education by American College of Mohs Surgery.