As part of our commitment to excellence, Mosaic Life Care offers Mohs surgery for skin cancer in St. Joseph by a fellowship-trained and board-certified physician through the American College of Mohs Surgery (ACMS), Isadore Tarantino, MD. The Mohs procedure is a highly effective treatment for skin cancer. It has the highest treatment rate compared to all other options, reaching up to a 99% cure rate, making Mohs surgery the gold standard treatment for skin cancer.
Dr. Tarantino removes thin layers of the affected area until there is no trace of cancer left, checking each layer during the procedure under a microscope for residual tumor markers. The method precisely removes cancerous skin while sparing healthy skin and tissue, making it ideal for skin cancers on cosmetically sensitive areas, large and aggressive tumors.
Mohs micrographic surgery is the gold standard treatment for removing skin cancer for its success rate, as well as being a cost-effective surgical option. It combines the procedure, pathology and recovery into one easy process. It is the only treatment option that evaluates 100% of the tissue margin, so no cancer cell is left behind.
The Mohs procedure will be an outpatient surgery in an onsite procedure suite. Typically, the process begins in the morning and ends the same day, depending on size and necessary reconstruction. You can continue taking all medication, eat and drink the day of the procedure. You will receive local anesthesia around the affected area and remain awake during the entire Mohs procedure. Make sure to plan a full day for the surgery, since it could take longer due to the size and depth of the affected area.
Once the area is numbed, Dr. Tarantino will remove the visible portion of the tumor and a thin layer of surrounding tissue. He will then examine the tissue for evidence of cancer and will continue this process until no cancer is detected.
After your procedure is finished, Dr. Tarantino will assess the wound and discuss options for reconstruction. If reconstruction is needed, it will usually happen that same day. You will then be given post-operative care and instructions on how to take care of the surgical site until fully healed.
Step-by-Step Process
Step 1: Dr. Tarantino will identify the affected area and plan what tissue to remove, give you local anesthesia and begin the Mohs procedure.
Step 2: The visible portion of the tumor, along with a thin layer of tissue surrounding the tumor, is carefully removed.
Step 3: Next, the removed tissue is taken into the onsite Mohs lab for analysis. The tissue is color-coded with dyes that correspond to the reference marks on your skin to show the source of the removed tissue. It’s then processed through a cryostat machine that cuts the tissue into sections to allow for complete margin analysis. The tissue is then placed on microscope slides and run through a linear stainer that stains the tissue, highlighting every single aspect of the tissue on a cellular level. A map of the surgical site is drawn to track the exact origins of the tissues removed.
Step 4: Dr. Tarantino will then examine the tissue under the microscope for evidence of remaining cancer.
Step 5: If remaining cancer cells are found, Dr. Tarantino will mark their origin on the map and return to remove another layer of skin from that precise location, leaving as much healthy tissue as possible.
Step 6: The Mohs procedure is repeated until no evidence of cancer is left anywhere in the surgical site. Then, Dr. Tarantino will discuss reconstruction and post-operative care.
Reconstruction
There are numerous reconstruction options Dr. Tarantino will discuss following the Mohs surgery.
- Small, simple wounds may not need any intervention to heal properly
- Slightly larger wounds may require stitches
- Larger or more complicated wounds may have a skin graft from another area of the body or a flap, which closes the affected area with skin adjacent to the wound
Post-Operative Care
Most patients have no issue in the recovery process after their Mohs procedure and only require minimal aftercare. If you receive a simple reconstruction or none, your care team will dress your wound and give you care instructions including:
- Information about how to keep the surgical site clean and when to change bandages
- Information for both prescription and over-the-counter medicines
- A timeline for when you can return to normal activities
- A schedule of follow-up appointments to remove any stitches and monitor healing
- Recommendations for treating your Mohs surgery scar to ensure it fades and heals quickly
FAQs
Why is it called Mohs surgery?
The term “Mohs” refers to Dr. Frederic Mohs, who developed this surgical technique in the 1930s. The technique has undergone many refinements and has come to be known as “Mohs micrographic surgery” or simply “Mohs surgery.”
What is Mohs surgery?
Mohs surgery is a highly specialized and precise treatment for skin cancer in which the cancer is removed in stages, one tissue layer at a time. It is an outpatient procedure, performed under local anesthesia, and it is distinguished by a specific technique where 100% of the tissue margins are assessed. This is unique to Mohs surgery.
Why is it important to have a fellowship-trained Mohs surgeon?
Fellowship-trained Mohs surgeons are specifically trained in the Mohs method, meaning they are the most qualified to perform the procedure as safely and efficiently as possible. They receive hands-on training in the Mohs method, learning proper techniques for tissue preparation, slide interpretation and advanced reconstruction techniques. This intensive training gives fellowship-trained Mohs surgeons a deep understanding of skin cancer, allowing them to deliver the highest level of care.
By choosing a fellowship-trained Mohs surgeon, you can trust that your surgeon has undergone the most rigorous training available for the method.
I don’t see anything after my biopsy. Do I really need to be treated?
Yes. The roots of skin cancer may spread deeper and wider than is visible. If they are not removed, the skin cancer can continue to spread and become more invasive.
Why does my skin cancer need to have Mohs surgery?
Mohs surgery has the highest cure rate and is appropriate for most skin cancers. It is also suitable for skin cancer that:
- Is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic results
- Was treated previously and has come back
- Is located near scar tissue
- Is large
- Does not have clearly defined edges
- Is growing rapidly or uncontrollably
- Is of an aggressive subtype
- Develops in immunosuppressed patients
How long does Mohs surgery take?
Depending on the extent of the skin cancer, the process is typically completed within one day but can be as quick as one to two hours. After the removal of the skin cancer, and while you are waiting for your tissue to be processed, you will be bandaged. You can sit in the waiting room, read a book or watch television to pass the time.
Will Mohs surgery leave a scar?
Yes. As with any surgery, Mohs surgery might leave a visible scar. The size will depend on the size of the affected area. However, Mohs surgery conserves as much normal tissue possible, making the smallest scar possible while effectively treating the skin cancer.
Is Mohs surgery the most cost-effective treatment option?
It is one of the most cost-effective skin cancer treatment options, because it is performed in a clinic setting and does not require the operating room or a hospital stay. The surgery, pathology and reconstruction are included into one fee.
