Mohs Surgery

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.

The best treatment for skin cancer is Mohs micrographic surgery. Named after Dr. Fredrick Mohs who developed this technique, it is a specialized method of removing skin cancers with a cure rate of 99.9% for skin cancer that has not been treated before. Our Mohs surgeon Dr. James Tidwell is an expert at treating skin cancers with this method being trained by Dr. Hugh Greenway who was trained by Dr. Mohs himself in the procedure.

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?

Mohs micrographic surgery is the gold standard for treating skin cancer. It is an advanced method of treatment offering the highest cure rate. Often skin cancers have various roots not visible to the eye. Using a microscope, a Mohs surgeon is able to trace and fully remove the entire tumor while leaving healthy tissue intact and unharmed. Our Mohs surgeon at Golden Coast Dermatology Skin Cancer, and Vein Center, Dr. James Tidwell, has been fellowship trained specifically in performing Mohs surgery at the Scripps MD Anderson Cancer Clinic in La Jolla, California under Dr. Hugh Greenway who learned the procedure for Dr. Mohs himself.

Mohs surgery allows for every single cell to be checked to ensure the tumor has been removed. After the tumor is removed reconstruction can begin with assurance that all the cancer is totally gone and in 99.9% of cases won’t come back.

Advantages of Mohs surgery include:

  • Single visit outpatient surgery done with local anesthesia thereby avoiding the risk of general anesthesia
  • Physician examines 100% of tumor that day to ensure entire cancer removed
  • Spares healthy tissue thus leaving the smallest scar possible
  • Has the highest cure rate of any method to treat skin cancer
"Dr Tidwell is one of the most caring doctors i have met. He has done two mohs surgery on me and they turned out perfect. One was Keystone Flap on my leg it turned out so well that I can hardly see where he did it. i would highly recommend him he is such a caring doctor he called at home each time i had the surgeries . I am getting ready. for another one, so i am not worried about it ,it is on my nose."
Glen Ivy
"I cannot express adequately in words what a great job Dr. Tidwell did with my Mohs surgery. I had a basal cell carcinoma on my forehead which required a large amount of skin to be removed. I was very nervous about the outcome, scarring, etc. Dr Tidwell was so kind and compassionate and truly went the extra mile to make sure I was informed about the procedure and comfortable with it. He even called the night of the surgery to check and see how I was feeling. It has been 6 months since my procedure and there is barely a scar! He did a fabulous job and I would highly recommend him to others!!!! We are fortunate to have him in our area! "
Kili Hanes

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. 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. 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. 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. 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. 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.

No. Most people do not have to stop their blood thinner. For those anxious about their procedure and risk of postoperative bleeding, we ask they discuss stopping their medication with their heart doctor to see if they are healthy enough to stop their blood thinner. For those who take aspirin, ibuprofen, or other NSAIDs for pain or routine heart health prevention not prescribed by a doctor, we recommend you avoid them if possible for two weeks prior to surgery.
Yes. Insurances cover Mohs surgery and wound repair.
Yes. Only local anesthesia is used and the patient is able to drive themselves home. Although a companion is welcomed and can be helpful on the day of surgery, it is not necessary. For those wishing for oral sedation, a driver is needed.
No. In fact, a good meal before coming is best.
Once cancer has been completely removed, the wound is evaluated and repaired. Most are repaired with a simple straight line closure. Others may require a small flap or skin graft.
We will discuss in detail how to care for your surgery site on the day of the procedure as well as give a handout. Non-adherent gauze pads, Vaseline or Aquaphor, paper tape, Tylenol, and an ice pack are all that are typically required.
Usually not. We discuss this on a case by case basis with the patient, but the vast majority of cases do not require either. Less than 5% of all patients require the need of pain pills or oral antibiotics. However, we will address your specific case, needs, and medical history to determine what is most appropriate for you and your care.
Anytime the skin is cut, there will be a line. Mohs surgery gives one the smallest scar possibly by saving 47% more tissue than other methods. At Golden Coast Dermatology, Skin Cancer, and Vein Center, we have a variety of lasers and methods to remove scars should any form.

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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. James Tidwell.

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