Approximately 1 in 5 Americans will develop skin cancer by the age of 70. More people are diagnosed with skin cancer each year than all cancers combined.
Call or make an appointment online today to see if Mohs surgery if it can help you or your family today.
What is Mohs surgery?
What does Mohs mean?
Mohs surgery was developed by Dr. Fredrick Mohs at the University of Wisconsin over 50 years ago. The surgery is named after him and thus called Mohs micrographic surgery to this day. While the process used to take days when Dr. Mohs invented it, advances have allowed the process to be refined to allow for the procedure to be performed in a few hours.
Dr. William James Tidwell was trained in an intensive fellowship program by Dr. Hugh Greenway in La Jolla, CA who learned Mohs surgery from Dr. Mohs himself.
Why remove skin cancers with Mohs micrographic surgery?
There are many available methods to treat skin cancer including traditional surgical excisions, Mohs surgery, electrodessication and curettage, cryotherapy, radiation, or chemotherapy. For tumors in cosmetically sensitive or difficult areas (i.e. head, neck, hands/feet, shins, and genitals), large tumors, cancers previously attempted to be treated, those with aggressive histological features, or poorly defined tumors, Mohs surgery offers the highest rate of completely removing the cancer while sparing the surrounding healthy tissue.
In Mohs surgery, the surgeon acts as both the surgeon and the pathologist. The specialized technique for processing the tissue allows for every cell along the margin of tissue removed to be examined. This allows for the surgeon to ensure that every single cancer cell has been removed during the procedure and that a maximum amount of healthy tissue remains. The cure rates for Mohs surgery are superior to surgical excision with frozen sections where only a few samples of the whole specimen are examined with the hope that the sample represents the entire tumor. In comparison, traditional surgery exams approximately 5% of the margin of skin cancer as opposed to Mohs surgery which offers 100% margin control.
In Mohs surgery, you know going home that day you are cancer free.
What happens during Mohs surgery?
Mohs surgery is comfortably performed in the office under local anesthesia. Mild oral sedation is available for patients that request it. This is much safer than using general anesthesia which puts the patient in a deep unconscious sedation by reducing recovery time with fewer side effects.
Once the anesthesia has taken effect, Dr. William James Tidwell will remove the visible skin cancer, process it in the onsite Mohs lab. A dressing is applied to the wound and the patient returns to the waiting room. Refreshments and media are available while the tissue is being examined. In the Mohs lab, the tissue is carefully processed and mapped in a three dimensional method. Dr. William James Tidwell reads the processed tissue with the aid of a microscope and prepares a map of any remaining tissue.
If cancer cells are still present at the edges of the removed tissue, the patient returns for an additional layer of tumor to be taken. More anesthesia is given and the patient made comfortable. Using the map of the remaining tumor as a guide, Dr. William James Tidwell carefully removes another layer of tissue only in the areas where the tumor remains. The process repeats itself until the entire cancer is 100% removed. Most tumors are removed in 1 or 2 layers and each layer takes about 45 minutes to an hour to process and examine.
Once the tumor is completely removed, the wound is repaired. The specific needs of the patient and the resulting defect are evaluated, discussed, and reviewed with the goal to maximize aesthetics and maintain functional capabilities. Most wounds are able to be closed in a small straight line with stitches. Others may require a flap or small skin graft to close.
What does it mean to be a fellowship trained Mohs surgeon?
A Mohs surgeon is a specially trained dermatologist who removes skin cancers and has also undergone specific training in the fields of pathology and reconstructive surgery. A fellowship is a rigorous and intensive training program one undertakes after graduating from medical school and in addition to completing a full dermatology residency. Chosen though an extremely competitive review and selection process, fellows are trained in a large number of Mohs surgery cases and reconstructions under a very senior and experienced mentor. This is in addition to a number of scientific research projects they must complete on the field of Mohs surgery before graduating.
Fellowship trained Mohs surgeons are then invited to be members of the American College of Mohs Micrographic Surgery, the oldest professional organization of physicians specifically trained in Mohs surgery.
Dr. William James Tidwell completed a Mohs surgery fellowship at the renowned Scripps-MD Anderson Hospital in La Jolla, California under Dr. Hugh Greenway who learned the procedure for Dr. Mohs himself.
Some common questions on the day of surgery:
Each layer of tissue examined takes about 45 mins to an hour to process. If cancer is still present, an additional micrographic layer is taken. Most tumors are cleared in 1 or 2 layers with the resulting repair taking 15 to 30 minutes.
We suggest patients bring a sweater or jacket because the surgery rooms are often kept at a cooler temperature. Shirts that button to allow for easy removal and into a gown are helpful for your convenience. A snack, book, and companion are often helpful as well.
BEFORE & AFTER
While Mohs surgery has many advantages, it may not be the right treatment for every patient or every instance of skin cancer. We consider many factors before determining if this surgery is the right one for you. If you have been diagnosed with skin cancer and want to discuss whether the Mohs process is appropriate for you, please call today or make an appointment online with with Dr. William James Tidwell.