What Is Mohs Micrographic Surgery?
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 Skin Cancer Diagnosis – What to Do?
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.
Advanced Skin Cancer Treatments: Dr. Weitzbuch
Dr. Weitzbuch is an award-winning, double-board-certified dermatologist and Mohs Micrographic Surgeon. He operates with the highest skill level and meticulous attention to protecting against excessive tissue loss. Unlike standard excisions done under general anesthesia that remove the cancerous tissue and some adjacent 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 critical consideration when cancer has appeared on visible face or body areas.
The Benefits of Mohs Surgery at Brilliance Dermatology
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.
Dr. Weitzbuch was recently featured in a documentary about mohs surgery for skin cancer. Click here to watch it.
Mohs Surgery in Calabasas: Dr. Hal Weitzbuch, Board-Certified Dermatologist
With Mohs, the surgeon can remove the entire tumor before repairing the skin. Therefore, this surgical technique boasts the highest complex skin cancer cure rate and minimal normal tissue removal. Statistically, 95 percent of recurrent skin cancers and nearly 99 percent of new cancers are cured via Mohs micrographic surgery.
Advanced Skin Cancer Treatment in Calabasas
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.
The Mohs Surgery Procedure: Step-by-Step
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.
Mapping the Cancer Growth
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.
Affected Tissue Removed Layer by Layer – Preserving Surrounding Tissue
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.
Reconstruction After Mohs Surgery
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.
Frequently Asked Questions
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:
- Skin cancers on the face where the cosmetic result is important for both function and appearance.
- Aggressive skin cancers that grow very quickly or have recurred after other treatments.
- Large skin cancers with ill-defined margins.
How Is Mohs Micrographic Surgery Performed?
Mohs surgery is performed right at Brilliance Dermatology 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.
What are the Advantages of Mohs Micrographic Surgery?
In addition to the highest cure rate, Mohs surgery offers superior cosmetic results and the highest cure rate. Mohs surgery allows dermatologists to preserve much more healthy tissue than other treatment methods.
While it is sometimes a more extended procedure, the patient will leave our office knowing that the cancer cells are entirely removed – which is a big relief after a frightening diagnosis. Entrust your care to Dr. Hal Weitzbuch, our double-board-certified dermatologist and Mohs micrographic surgeon, and our team of fantastic support nurses at Brilliance Dermatology.