Over the years, the expert surgeons at California Skin Institute have helped tens of thousands of patients beat skin cancer through Mohs surgery. This is an advanced tumor removal procedure that involves a high level of expertise and real-time microscopic tissue analysis. If you or a loved one have been diagnosed with skin cancer and would like to schedule a Mohs surgery consultation, please set up an appointment by calling a California Skin Institute practice near you, or email us through the Contact Form.
Why Mohs Surgery for Skin Cancer?
Alternate versions of skin cancer surgery may involve excision of the tumor, with the tissue being sent to a pathology lab for review. Unfortunately, this process can sometimes lead to incomplete tumor removal due to the fact that the procedure assumes the shape of the tumor is always proportional. Further, pathology labs typically analyze only a small portion (typically less than 1%) of the excised tissue.
Thus, cancerous cells can sometimes be left behind, causing recurrence of the cancer and lowering rates of survival. Additionally, in an effort to reduce chances or recurrence, surgeons often have to remove significantly larger portions of surrounding healthy skin, causing extensive scarring.
Mohs surgery is able to address some of the problems with traditional excision, and provide a higher cure rate, smaller sacrifice of normal skin, and a smaller scar.
One of the cornerstones of Mohs surgery has to do with the evaluation of the removed tissue. Instead of sending the excised skin to a traditional pathology lab, 100% of the tissue border is examined with Mohs surgery with frozen tissue sections while you wait in the office. The Mohs surgery pathology turnaround time is less than an hour whereas the pathology laboratory needs over 24 hours for traditional pathology with permanent tissue fixation.
The benefit of examining tissue during the surgery is that it allows your CSI Mohs surgeon to a) see if any cancer cells have been left behind, and b) pinpoint the specific location of any remaining portions of the cancerous tumor. The goal is to eliminate the guesswork in estimating the size and location of the growth and it is all done in less than one hour.
How Mohs Surgery Works
During Mohs micrographic surgery, a California Skin Institute surgeon will first excise the tumor in a circular shape, resembling a pie. Once the tissue has been removed, the surgical team will divide the entire border of the excised tissue into small sections, which are then stained and analyzed under a microscope.
It is helpful to think of the border as the crust of a pie. This includes the entire circumference of the excised tissue, as well as its bottom section. The Mohs surgeon is not concerned about the pie filling and is only examining the entire pie crust representing 100% of the margin.
By examining the pie crust in its entirety, your California Skin Institute Mohs surgeon is able to assess whether the tumor grew asymmetrically into any direction. If the analysis reveals that portions of the tumor still remain in the skin, your surgeon will be able to pinpoint the exact location for further excision.
This ability to point where the remaining cancer cells are located is highly useful, because it tells the surgeon the exact location where more tissue needs to be removed.
Any additional sections that are excised during the process are also analyzed under the microscope. The process continues until microscopic analysis no longer shows presence of cancer cells.
Because the excised tissue is analyzed during the Mohs procedure, you get the answer of clear margins the same day. This means that reconstructive surgery can begin right after tumor removal is complete (with traditional excision, patients would sometimes need to wait for pathology results to begin the reconstruction process).
What to Expect During Mohs Surgery
The typical Mohs surgery procedure can last anywhere from a few hours to the entire day. This will vary from patient to patient, depending on how extensively the tumor has grown. A tumor that is more asymmetrical or has longer tentacles will require more stages or excisions to clear the tumor.
After the initial segment of the skin is excised, you will return to the waiting room, while the California Skin Institute medical team segments, stains and analyzes the tissue border. If analysis shows presence of cancer cells in the border, you will be asked to return to the procedure room, where additional tissue will be removed for analysis. This process will continue until analysis shows that the tumor has been removed completely.
Upon completion of the excision, you and your California Skin Institute Mohs surgeon will discuss the best way to close the wound in your situation.
The Mohs surgery team will provide you with complete aftercare instructions, based on your unique situation and the area of the body that is being treated.
Mohs Surgeons at CSI
California Skin Institute has helped thousands of patients treat skin cancer through Mohs micrographic surgery. Our founder and CEO, Dr. Greg Morganroth, has himself performed over 25,000 Mohs surgery procedures since 1995, and has worked very hard to invite some of the best Mohs surgeons to CSI, so that more Bay Area patients could have access to this life-saving procedure.
As of today, our team has eight highly trained and experienced Mohs surgeons, helping patients in numerous CSI locations:
Dr. Greg S. Morganroth** (Mountain View, San Jose – Los Gatos)
Dr. Blake Alexander (Modesto)
Dr. Katharine Ball** (San Jose-Los Gatos, San Mateo)
Dr. Lauren E. Gebauer** (Castro Valley)
Dr. Richard Hambley** (Monterey-Ryan Ranch)
Dr. Francis Hsiao** (Daly City, San Francisco – Pacific Heights, San Mateo, Santa Rosa)
Dr. David South (Freedom)
Dr. Peter Webb (San Mateo)
**Members of the American College of Mohs Surgeons
Other Skin Cancer Treatments
In addition to Mohs micrographic surgery, California Skin Institute providers may also suggest a number of other treatment options, based on the patient’s unique situation and medical needs. Such treatment options can include standard excision, radiation therapy, topical therapies, and electrodessication and curettage.
Taking the Next Step
If you have been diagnosed with skin cancer and would like a second opinion (or if you’ve noticed strange moles or spots on the skin, and would like a skin cancer evaluation), please schedule an appointment with one of the expert providers at a California Skin Institute practice near you, or send us an email through the Contact Form.