What Is a Mohs Surgeon, When Should You See One, Where Can You Find One.

Been enjoying plenty of backyard & outside time during Summer 2020? Hopefully you’ve been using sunscreen judiciously and every 2 hours as advised, and that you have your annual or biannual skin check scheduled. Even in the midst of the COVID crisis, regular skin checks are very necessary. Would it surprise you to know that since the crisis started, Dermatology, Laser & Vein Specialists of the Carolinas have discovered and treated hundreds of skin cancers, from basil cells to melanomas.  So…if you have noticed any new, changing, or non-healing spots on your skin, the sooner you have a check-up with a board-certified dermatologist, the better.

Here are a few eye opening statistics regarding skin cancer from the American Academy of Dermatology:

• Skin cancer is the most common cancer in the United States
• Current estimates are that one in five Americans will develop skin cancer in their lifetime
• Research estimates that nonmelanoma skin cancer, including basal cell carcinoma and squamous cell carcinoma, affects more than 3 million Americans a year
  • Women have been having the greatest increase in incidence rates for both types of NMSC (Nonmelanoma Skin Cancer)
  • NMSC incidence rates are increasing in people younger than 40

Skin Cancer Removal

If you do end up facing a skin cancer diagnosis at some point, depending on the location and type of cancer, your doctor may recommend a Mohs surgeon for removal of the cancer. While there are several effective methods for treating skin cancer, Mohs Micrographic Surgery carries the highest success rates and lowest rates for recurrence. It is simply the best surgical technique for curing skin cancer. Mohs surgery is the preferred technique for cancer removal where preserving tissue is especially important (i.e. nose, eyelids, ears, lips, scalp, hands/feet, genitals) and for skin cancers that are large, fast-growing, ill-defined, recurrent or located in areas of the body where recurrences are likely. 

The basic idea is that the surgeon progressively removes thin layers of tissue around the skin cancer in stages, examining each layer until only cancer-free skin remains. The goal of Mohs surgery is to remove the entire cancerous tumor, or as much of it as possible, thereby doing minimal damage to surrounding healthy tissue. Mohs Surgery is widely-accepted across the globe as the gold standard in complex skin cancer removal. It is recognized for both its high cure rates and lowered risk of complications & disfiguring scars; cure rates reach as high as 99% for Basal Cell Carcinomas and 95% for Squamous Cell Carcinomas and skin cancers previously treated with another method.

Mohs Surgery in Charlotte

At Dermatology, Laser & Vein Specialists of the Carolinas, Dr. Gilly Munavalli performs this highly specialized procedure, during which he serves simultaneously as dermatologic surgeon, pathologist & reconstructive surgeon. Dr. Munavalli completed his training in Mohs Micrographic Surgery fellowship at The University of California San Francisco, a program approved by the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMS). 

How Mohs Surgery Works

What sets Mohs surgery apart from other methods is that you don’t leave the office until the cancer has been completely removed and repaired, effectively averting the chance for regrowth. How long does this take? Mohs surgery is a procedure performed in stages, and it can be difficult to predict exactly how many layers will be necessary for complete removal. Simply put, Dr. Munavalli follows the tumor spread microscopically and removes only what is necessary, until it is completely gone. As a result, the full process may take as little as one hour for a small tumor or up to the majority of the day for larger or more for skin cancers located in anatomically challenging areas. 

Mohs surgery is almost always completed from start to finish in the Mohs surgeon’s office. The process starts with a local anesthetic, and then Dr. Munavalli removes the visible portion of the cancer along with a thin, underlying layer of tissue that’s slightly larger than the visible tumor. A temporary bandage is placed on your incision. This takes only a few minutes.

The tissue is then analyzed in the lab. You can expect to wait about an hour in the waiting room for the results. While you’re waiting, the tissue is frozen, cut into razor thin sections and placed on a slide. Dr. Munavalli then examines them with a microscope, taking great care to keep track of the exact spot where each piece of tissue was removed by making a map. That way, if a small area of cancer is found in one piece of tissue, he knows precisely where to continue with the surgery.

If cancerous cells remain visible in any part of the tissue slide, your Mohs surgery will continue. Dr. Munavalli will remove an additional layer from just the area where cells are present, taking care to leave as much healthy tissue as possible intact. This tissue will again be examined in the laboratory, and so on.

The process is repeated, if necessary, until the last tissue sample removed is cancer-free. Your anesthetic will be re-administered as needed, and you’ll be in the office waiting room in between procedures. Patients are usually advised to plan to stay for the majority of the day, although it typically doesn’t take more than a few hours for most. 

One of the biggest advantages of Mohs surgery is that when you leave, you’ll know with up to 99% certainty that the tumor is gone. You’ll have a follow-up visit at DLVSC to remove stitches (if needed) and to monitor your recovery to make sure your wound is healing properly. In many cases, Dr. Munavalli will perform laser or other treatments, at no charge, in the 6 to 8 weeks after surgery to make sure you have the best outcome possible with regard to your scar.

Follow-up

Mohs surgery has the highest cure rate for skin cancer; however, you will always have a very small risk of cancer recurrence. You will also need to prioritize annual skin checks with your dermatologist, because those who have been diagnosed with skin cancer have an increased risk for more in the future. As many as half the people diagnosed with the most common types of skin cancer will develop another skin cancer again within five years. Your dermatologist will also recommend an annual skin check if you have a family history of melanoma, in order to watch closely or any new or changing moles.