About Mohs Surgery
Mohs micrographic surgery, developed in the 1930s by Dr. Frederic Mohs, has been developed and refined over nearly a century to become one of the most effective skin cancer treatments. This surgery can successfully remove many types of skin cancer, including melanomas, basal and squamous cell carcinomas, and others. The unique Mohs process involves removing the tumor layer by layer and carefully examining each layer microscopically for cancerous cells. This not only increases the ability to excise all of the cancer, but it also allows the surgeon to leave the most healthy skin intact.
At Pacific Skin and Cosmetic Dermatology Corte Madera, Mohs surgeries are performed by Tracy Evans, M.D., a fellowship-trained Mohs surgeon, skin cancer specialist, and board-certified dermatologist. She has over ten years of experience with Mohs and other skin cancer treatments.
Mohs Surgery Reviews
"I have been seeing Dr. Evans for approximately four years. She and her medical staff have been very attentive to my skin care needs. I recently had Mohs surgery for squamous cell carcinoma with great results. Her follow-up has been great. I am also pleased with some of the cosmetic treatments I've had as well. Lastly, I like the convenience of being able to see her in San Francisco and Marin."- E.B. / Yelp / Jul 19, 2017
"I highly, highly recommend Dr. Evans as a doctor for skin cancer. She really knows her stuff and is trained in Mohs surgery (not many dermatologists are!). I really appreciate that she uses the latest technology to keep track of any spots on your skin and has a suspicious eye. I have had doctors in the past who did a quick skin check and literally missed the mark. I can’t really speak to the more cosmetic aspects of her practice, but I do not like how products are offered to me at the end of my appointment. Without being upfront about their cost or the fact that products are not returnable, Dr Evans’ assistant will present the products she recommends I purchase at the end of my appointment. (There is a small sign by the register about the return policy.) I know that these are vetted products and they must help her practice thrive, but I wish I could be offered either a drugstore alternative or a pharmacy prescription option. I’m sure the cost is not an issue for many of her patients, but it is for me and I am simply not able to do what she recommends as far as products are concerned. However, I find her to be so incredibly smart and trustworthy when it comes to skin cancer that I can simply overlook this part of the appointment."- E.R. / Yelp / Aug 18, 2020
The Mohs surgery procedure is typically employed to remove squamous cell carcinoma and basal cell carcinoma, the two most prevalent types of skin cancer. Melanoma and other uncommon types of skin cancer can also be treated with Mohs, though only in certain circumstances. At your consultation with Dr. Evans, she can talk with you about whether you're an ideal candidate for Mohs surgery. There are also several other factors that affect candidacy for Mohs.
It is the ideal choice if your cancer presents a higher risk of recurrence or has already returned post-treatment. Lesions or tumors in aesthetically important or functionally sensitive areas, like the ears, eyes, mouth, or nose, are also good candidates. Finally, Mohs is best for areas of skin cancer that are big, fast growing, or have blurry boundaries.
Dr. Evans performs Mohs surgery as an outpatient procedure with local anesthetic at Pacific Skin and Cosmetic Dermatology Corte Madera. Once your anesthetic has taken effect, Dr. Evans begins by surgically excising the observable skin cancer, as well as a very thin layer of surrounding tissue. The removed tissue is then sectioned into quarters that are dyed and marked to coordinate with a Mohs map — a diagram that is invaluable in mapping where any further cancer cells are discovered during the next step.
The dyed and marked tissue is then frozen, and Dr. Evans analyzes it under a microscope. Very thin layers are taken from the bottom and outside edges for examination, and any cancerous cells found are marked on the Mohs map in the appropriate spot. Dr. Evans uses the map to remove another layer of tissue where cancer is indicated, leaving the clear tissue untouched, and the process repeats until no residual cancer is detected.
The duration of a Mohs surgery depends on the phase of the cancer, how long it was present, and how many layers need to be removed. After your Mohs procedure, the method used to close the wound will depend on how large and deep it is. Dr. Evans can close small wounds easily with sutures while larger wounds may need a skin graft. Very large wounds might require reconstructive plastic surgery.
What to Expect
Immediately after your surgery, Dr. Evans will discuss the results with you, as well as whether or not you will need any reconstruction in the treatment area and when it should be performed. If reconstruction is necessary, she will discuss all the options with you. These include simple sutures, skin grafts, and referring you to a plastic surgeon, depending on the size of your Mohs wound and its location.
Once you are bandaged and everything has been discussed with Dr. Evans, you will be able to drive yourself home. Most patients are fine to get back to work and their everyday routines by the next day. However, you will need to avoid strenuous or heavy activities for about two weeks. If Dr. Evans closes your Mohs wound with sutures, they will be removed at your first follow-up visit in 1 – 2 weeks.
At the site of your treatment, you might experience numbness, itching, shooting pains, and temporary weakness that will decrease as the Mohs wound heals. Some patients, depending on their skin type and the depth of their Mohs wound, may experience a small permanent area of numbness, skin discoloration, or keloid scarring. However, most patients feel these are tolerable side effects due to the high success rate of Mohs surgery, which is nearly 99%. It is important to know that 40% of men and women who develop skin cancer will have a later occurrence in another location so twice-yearly exams are crucial.
Frequently Asked Questions
How much does Mohs surgery cost?
Mohs surgery is often covered by insurance because it is a medical procedure. Our office is happy to contact your provider to determine your coverage and if you will have any out-of-pocket costs. At Pacific Skin and Cosmetic Dermatology Corte Madera, we accept many payment options, and if necessary, will help you find medical financing to make your procedure affordable.
What is the success rate?
Mohs surgery has some of the highest success rates of any skin cancer treatments. For main basal cell carcinoma, Mohs has a 99% success rate, and with primary squamous cell carcinoma, it has a success rate of around 97%.
Will I feel pain during Mohs?
Local anesthesia is used during the surgery so most patients do not experience any pain. Some patients report some mild discomfort. Medication is not usually necessary after surgery as most patients experience minimal pain. However, if you do have any pain or discomfort afterward, Dr. Evans typically recommends an over-the-counter painkiller.
Will I have a scar?
The size and visibility of any scarring will vary from patient to patient. Factors that affect scarring are the size of the cancerous tissue, how deeply the Mohs needs to be done, and your skin type. The larger and deeper your surgery, the more likely it is that there will be a scar. Dr. Evans always does everything possible to minimize scars. Once you are fully healed, she might recommend that you have a scar revision procedure.
How many Mohs treatments are necessary?
Every patient with skin cancer is different and has his or her own unique needs so it is impossible to accurately predict if you will need a second surgery. At your first appointment, Dr. Evans will go over the chances of you needing another treatment. However, Mohs surgery success rates are almost 99% so most patients do not need further surgery.
receive Superior Care
If you or a loved one has been diagnosed with a form of skin cancer, the most important thing you can do is look for a fully trained Mohs surgeon with real experience. While Mohs surgery has the highest success rates for skin cancer treatment, this success is dependent on your surgeon's skills. Dr. Evans at Pacific Skin and Cosmetic Dermatology Corte Madera has the skills and experience necessary so we urge you to schedule your consultation soon so she can get started on your treatment.