Mohs surgery is a surgical cancer treatment technique that gives dermatologists the ability to remove skin cancers, layer by layer, until there are "clear margins" and no cancerous cells remain.
A dermatologist trained in Mohs surgery will examine each layer of tissue under a microscope and look for evidence of cancer and will continue to excise thin layers until no cancerous cells are detected.
A diagnosis of skin cancer can be devastating, but Mohs micrographic surgery is the most advanced, precise and effective treatment for skin cancer types like basal cell carcinoma and squamous cell carcinoma.
Dr. Weitzbuch is an award-winning, board-certified dermatologist who performs Mohs Surgery with the highest level of skill and meticulous attention to protecting against excessive tissue loss. Unlike standard excisions done under general anesthesia that remove not only the cancerous tissue, but also some adjoining healthy tissue, Mohs is an outpatient procedure that uses local anesthesia and removes skin cancer while limiting damage to nearby healthy tissue. This can be a very important consideration when the cancer has appeared on visible face or body areas.
During Mohs, Dr. Weitzbuch removes one thin layer of cancerous skin at a time, mapping, color-coding and microscopically examining each layer until all the cancerous tissue is gone. The ability to look at each affected skin layer, with 100 percent margin control, increases a patient's chance of remission and lowers the risk of future recurrence.
Mohs micrographic surgery is an excellent treatment option for cancers of the skin with aggressive tendencies, a high recurrence risk, a large size, difficult-to-define borders and locations where preserving healthy tissue is key for preserving function.
With Mohs, the surgeon can ensure the entire tumor is removed before repairing the skin. Therefore, this surgical technique boasts the highest complex skin cancer cure rate along with minimal normal tissue removal. Statistically, 95 percent of recurrent skin cancers and nearly 99 percent of new cancers are cured via Mohs micrographic surgery.
In contrast, typical excisions where a smaller percent of tissue margins is examined later, causes a higher risk of missed residual tumors that require more procedures. Additionally, the local anesthesia used during Mohs carries less risk than standard surgery under general anesthesia. Our clinic serves the areas of Calabasas, Malibu, Thousand Oaks, Westlake Village and beyond. Finding a highly-skilled Mohs Surgeon can give you the confidence that a skin cancer will be completely removed while preserving face or body tissue.
First, local anesthesia is applied to the site. Once the skin tissue is numb, Dr. Weitzbuch may use a scoop-shaped curette to gently scrape the tumor, which allows him to determine the margin between healthy tissue and cancerous cells.
Then, Dr. Weitzbuch will excise the clinically apparent skin cancer, with a small margin of healthy appearing skin around it.
After the first tissue layer is excised, a map of the tissue and its location in relation to nearby body landmarks is created. This map guides the surgeon to the tumor's exact location. Labels and color codes are applied to the tissue, correlating its place on the drawing. Finally, the patient is bandaged and permitted to rest outside the operating area.
After the slide is processed by a technician here in the office, Dr. Weitzbuch will study each layer of tissue to determine if any cancerous cells remain. The process takes roughly one hour per stage. Depending on the complexity of the skin cancer, there may still be cancerous cells at the tissue margin, requiring additional surgical stages until all the affected cells have been removed. If more stages are necessary, Dr. Weitzbuch will review the map, excise another layer of tissue, and examine the tissue for lingering cancerous cells.
Once all the cancer is removed, Dr. Weitzbuch can reconstruct the surgery site for function and aesthetic purposes, using advanced plastic surgery techniques. We offer an individualized approach, and depending on the wound, Dr. Weitzbuch may let the area heal on its own, close it with stitches, graft it or perform a flap, or send the patient to one of his trusted colleagues for more advanced facial reconstruction procedures. Patients are seen post-operatively to ensure proper healing and should be followed at least every 6 months to check the presence of any newly-formed cancerous skin growths.
What Types of Cancer Can Be Treated with Mohs Micrographic Surgery?
Mohs surgery offers the highest cure rate among skin cancer treatments and it is effective on almost any basal cell and squamous cell carcinoma; however, Mohs is especially appropriate for:
Mohs surgery is performed right in the Calabasas Dermatology Center in our outpatient surgical suites. The area to be treated is numbed with a local anesthetic. Dr. Weitzbuch will first remove the visible portions of the lesion or tumor with a small margin and will examine them under the microscope. Then he will remove a thin layer of tissue surrounding the tissue margins and examine them, as well. This process will continue until all the cancerous cells have been removed.
Because each tumor is different, it is impossible to know in advance how long the surgical appointment will require. Some may take an hour or two, others may take an entire day. Dr. Weitzbuch is also specially trained in plastic surgery closure techniques and will close the remaining defect after removal of all tumor cells for superior cosmetic results.
After bandaging the surgical sites, our team of registered nurses will discuss how to care for the incision in the following weeks. Sutures are typically removed between four days and two weeks post-op, depending on the type and size of the closure, as well as location. We can also provide pain medication for patients if needed. Additionally, there is always a provider on call for any post-operative emergencies, which are extremely rare.
In addition to the highest cure rate, Mohs surgery offers superior cosmetic results and the highest cure rate. Mohs surgery also allows the dermatologist to preserve much more healthy tissue than other treatment methods.
While it is sometimes a longer procedure, the patient will leave our office knowing that the cancer cells are completely removed – a big relief after a frightening diagnosis. Trust your care with our board-certified dermatologist Dr. Hal Weitzbuch, and our team of amazing support nurses at the Calabasas Dermatology Center.
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