Mohs Skin Cancer Surgery

Aza Lefkowitz, M.D., F.A.A.D. Director of Mohs Surgery at Advanced Dermatology P.C. and The Center for Laser and Cosmetic Surgery

Mohs Micrographic Surgery has been available since 1991. This procedure, though appropriate for almost all skin cancer, is the treatment of choice for patient’s with large or poorly defined basal or squamous cell carcinomas as well as for most of the face, finger, and skin regions. Your patients can have the best treatment modality for skin cancer cases with acceptance of most insurances, thereby alleviating the high cost normally associated with this procedure.

PROMPT ACTION is your best protection. The pictures below show atypical normal moles and melanomas.

Advantages of Mohs Surgery

  • Tissue sparing-least amount of normal tissue taken
  • Highest cure rate of any technique for Basal Cell or Squamous Cell Carcinomas
  • Lesions completely removed-in only one visit
  • Excellent cosmetic results
  • Less anxiety-no need for re-excision

Indications for Mohs

  • Large lesions on the face, scalp & ears
  • Poorly demarcated skin cancers
  • All recurrent lesions
  • Need for removal in one visit
  • Need for smallest scar possible

Specialized Mohs Team

  • Experienced Board Certified fellowship trained Mohs micrographic surgeon with thousands of cases of experience.
  • Mohs laboratory technician for tissue processing
  • Trained staff, surgical / medical assistants
  • CLIA certified laboratory on premises
  • Anesthesiologist available, for the appropriate patient

Conveniences of our Mohs Center

  • We accept most insurances on all doctor referred patients (including most HMOs, IPOs, and IPAs-see insurance Infocard)
  • Personalized, skilled care in an office setting
  • Private phone number for Mohs surgery: F.M. (718)357-0717 Ros. (516)625-0993 SB (631)751-6647 and W.I. (631)587-2136
  • Convenient public and private transportation-call our office for easy routes
  • 24 hour answering / paging service
  • Car service and other amenities are available for selected patients.

What is Mohs Micrographic Surgery?
Mohs micrographic surgery is named in honor of the physician who developed the basic technique, Dr. Frederic Mohs. You may hear it called Mohs surgery, microscopically controlled surgery, chemosurgery, or histographic surgery-it’s all the same.

When is Mohs Surgery Indicated?
Mohs Micrographic Surgery is now universally recognized as the most precise method for treating skin cancers. It is especially effective in cancers of the face or in other cosmetically sensitive areas, because it can eliminate virtually all cancer cells while causing minimal damage to the surrounding normal skin.

Mohs Micrographic Surgery is also ideal for the removal of recurrent skin cancers-tumors that reappear after treatment and can plague a patient repeatedly. While skin cancers are easily visible to the patient, individual cancer cells are microscopic and any cells left behind can cause the tumor to reappear. The tumor may spread beyond its obvious external margins, with “nests” of cells growing in unpredictable areas.

Cost of Mohs Micrographic Surgery
Mohs Micrographic Surgery is a technically demanding procedure; it is also highly cost effective, because fewer return visits to the dermatologist’s office are needed for treatment of a recurring lesion. At Advanced Dermatology P.C. and The Center for Laser and Cosmetic Surgery we accept most insurances for this procedure including HMOs, PPOs, & Medicare.

Rationale for Mohs Micrographics Surgery
The technique produces the smallest possible wound in the removal of any given tumor. The smaller the wound, the greater are the chances for good cosmetic result after the wound has completely healed. This is particularly important on the face, where a good appearance after surgery is usually of concern to the patient. The cure rate for a primary lesion is 99% in some studies and over 95% for recurrent lesions. Tumors can almost always be totally removed in one treatment session.

Mohs Surgery vs Traditional Treatment
The main difference between micrographic surgery and other methods of removing skin lesions is microscopic control. In Mohs surgery multiple thin, horizontal layers of the cancer are removed, allowing the viewing of the entire border-all the deep and lateral margins continuously. The surgical removal proceeds along a grid pattern, with each layer carefully identified and “mapped” with special dyes by the Mohs surgeon so that its exact location can be pinpointed on the wound, (see picture below).

Mohs Surgery vs Traditional Treatment
This illustration shows the difference between Mohs Micrographic Surgery, with lateral and horizontal sectioning or “mapping”, and; traditional/vertical sectioning. As you can see, traditional sectioning can sometimes leave “nests” of cancer cells behind, allowing the cancer to remain grow. With the Mohs technique, the cancer would be detected and cured.

When cancer cells are seen within the specimen’s margin, the surgeon continues to remove and examine tissue layers only from that section of the wound-not requiring re-excision of the entire specimen. This process continues until all the cancer cells are completely eradicated. In addition, since only the cancerous tissue is removed, this saves as much normal skin as possible.

Before and After Surgery
Mohs Micrographic Surgery is performed on an outpatient basis in one of our surgery suites with a local anesthetic administered by the tumor. Surgery usually begins early in the morning and is finished within several hours. However, if the tumor is extensive it may require most of the day.

The laboratory preparation and examination under the microscope, all performed in our onsite laboratory, are the most time consuming parts of the procedure. While waiting for the lab results, a temporary dressing is applied.

Periodic visits to your regular dermatologist are recommended to check on your progress and spot any possible cancer recurrence as soon as possible. One of five patients with one skin cancer will develop another within five years, so follow-up is extremely important for early detection of any new lesions.

Who Performs Mohs Surgery?
Mohs Surgery is performed only by a Mohs Micrographic Surgeon; a dermatologist with at least a year of additional intensive training in all aspects of the technique, at an accredited program and who has performed hundreds of cases.

Mohs Micrographic Surgeon (Board Certified Dermatologist with specialized training in Mohs Surgery and Reconstructive Surgery from an accredited Fellowship Program)

  • Mohs lab technician for tissue processing
  • Trained Nursing staff
  • Surgical / Medical Assistants
  • Special Laboratory on premises (OSHA certified)
  • Home after-care visits available, when indicated
  • Anesthesiologist available, when necessary

RELATED TOPICS AND OUR DOCTORS IN THE NEWS

OUR PATIENT EDUCATION LIBRARY

Scientific Abstracts

  • View Scientific Abstracts on Melanoma
  • View Scientific Abstracts on Basal Cell Carcinoma
  • View Scientific Abstracts on Squamous Cell Carcinoma