Why should I choose Integrated Dermatology for my Mohs Micrographic Surgery?

Here at Integrated Dermatology, we understand that your choice of a skin cancer surgeon is based on their expertise, core competency and high patient care.  We are confident that Dr. Farhaad Riyaz and our team meet all three criteria that you are looking for.  We appreciate your trust in us to provide you with the highest gold standard of care.

What is Mohs Micrographic Surgery?  

Originally developed in the 1930s, Mohs micrographic surgery has been refined into the most advanced, precise, and effective treatment for an increasing variety of skin cancer types. With the Mohs technique, physicians can precisely identify and remove an entire tumor while leaving the surrounding healthy tissue intact and unharmed.  Mohs surgery is the most effective treatment for most types of skin cancer.


What is the success rate of Mohs Surgery?

The Mohs procedure involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached (called clear margins). Because the Mohs Micrographic surgeon is specially trained as a cancer surgeon, pathologist, and reconstructive surgeon, Mohs surgery has the highest success rate of all treatments for skin cancer—up to 99%.

What are the advantages of Mohs Surgery?

Mohs surgery is unique and so effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. The pathologic interpretation of the tissue margins is done on site by the Mohs surgeon, who is specially trained in the reading of these slides and is best able to correlate any microscopic findings with the surgical site on the patient. Advantages of Mohs surgery include:

  • Ensuring complete cancer removal during surgery, virtually eliminating the chance of the cancer growing back

  • Minimizing the amount of healthy tissue lost

  • Maximizing the functional and cosmetic outcome resulting from surgery

  • Repairing the site of the cancer the same day the cancer is removed in most cases

  • Curing skin cancer when other methods have failed

  • Being superior to other skin cancer treatment methods which blindly estimate the amount of tissue to treat, which can result in the unnecessary removal of healthy skin tissue and tumor re-growth if any cancer is missed.

Why does my cancer need Mohs Surgery? 

Mohs surgery offers the highest cure rate among treatments for skin cancer and can be used for practically any type of skin cancer. There are many other acceptable skin cancer treatment options, including freezing (cryosurgery), curette & dessication, surgical removal (excision), and radiation therapy, which all require the surgeon to estimate how extensively to treat the area around the tumor. There are many advantages to Mohs surgery compared to other treatments, including its high cure rate and cost-effectiveness. It is especially appropriate for skin cancers that:

  • Develop on areas where preserving cosmetic appearance and function are important

  • Have recurred after previous treatment or are likely to recur

  • Are located in scar tissue

  • Are large

  • Have edges that are ill-defined

  • Grow rapidly

What should I expect for the Mohs Surgery?

Mohs surgery is an outpatient procedure in the office. Preparation is done for immediate preparation and microscopic examination of the skin tissue. Typically, surgery starts early in the morning and is completed the same day, depending on the extent of the tumor and the amount of reconstruction necessary.

Local anesthesia is administered around the area of the tumor, as the patient is awake during the entire procedure. The use of local anesthesia in Mohs surgery versus general anesthesia provides numerous benefits, including the prevention of lengthy recovery and possible side effects from general anesthesia. After the area has been numbed, the Mohs surgeon removes the visible tumor along with a thin layer of surrounding tissue. This tissue is prepared and put on slides by a technician and examined under a microscope by the Mohs surgeon. If there is evidence of cancer, another layer of tissue is taken from the area where the cancer was detected. This ensures that only cancerous tissue is removed during the procedure, minimizing the loss of healthy tissue. These steps are repeated until all samples are free of cancer. While there are always exceptions to the rule, most tumors require 1 to 3 stages for complete removal.

When the surgery is complete, the Mohs surgeon will assess the wound and discuss options for ideal functional and cosmetic reconstruction. If reconstruction is necessary, the Mohs surgeon will usually perform reconstructive surgery to repair the area the same day as the tumor removal.

What is the Post-Operative Care after I have had Mohs Surgery?

While treatment of your skin cancer is your primary concern, reconstruction of the treated area is also important. After your Mohs surgeon is confident that all of the cancer has been removed, your Mohs surgeon and you will determine how the wound will be repaired. In addition to removing skin cancer, fellowship trained Mohs surgeons have specialized reconstructive surgery training for repairing the wound.

What are my options for Reconstruction after Mohs Surgery?

While your surgeon might be able to give you an idea of whether your reconstruction should take place immediately after surgery or be delayed until later, it's impossible to know the extent of the cancer in advance.

After determining that the affected area is cancer free and reconstruction is necessary, the Mohs surgeon will review skin cancer reconstructive surgery options with you. Depending on the size of the tumor, depth of roots, and location, one of the following options will be selected: 

  • Small, simple wounds may be allowed to heal by themselves (process known as secondary-intention healing)

  • Slightly larger wounds may be closed with stitches in a side-to-side fashion

  • Larger or more complicated wounds may require a skin graft from another area of the body or a flap, which closes the defect with skin adjacent to the wound

  • On rare occasions, the patient may be referred to another reconstructive surgical specialist

Will I need to come back to the office after Mohs Surgery for my skin cancer? 

Your surgeon will arrange post-surgical check-ups after Mohs surgery to monitor your recovery and spot any possible cancer recurrence as soon as possible. Since 2 out of 5 patients with one skin cancer will develop another within 5 years, follow-up is extremely important for early detection of any new lesions. *

*All Mohs Surgery information described above was provided by American College of Mohs Surgery (ACMS). For more information about Mohs Surgery, please visit: http://www.skincancermohssurgery.org/

Is Mohs Micrographic Surgery the right treatment for your skin cancer?

Email us at MOHS@washingtondcderm.com