Mohs surgery, performed by Dr. Philip Hughes (a Fellow of the American Society for Mohs Surgery), is microscopically controlled surgery that is highly effective for common types of skin cancer, with a cure rate of up to 99% for basal cell cancer, the most common skin cancer. Because the Mohs procedure is micrographically controlled, it provides precise removal of the cancerous tissue, while healthy tissue is spared. For this reason, Mohs surgery results in a significantly smaller surgical defect and an improved cosmetic result compared to other methods of skin cancer treatment. The Mohs procedure is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desired for cosmetic and functional purposes (the face, eyelids, nose, ear, fingers, genital area), for cancers with indistinct margins, and for recurrent cancers in scar tissue. It is especially indicated for lesions that have recurred following prior treatment, or for lesions in anatomic areas that have the greatest likelihood of recurrence (eg., the side of the nose).
Many skin cancers do not require Mohs surgery and may be treated by simple excision, curettage and electrodessication, cryosurgery with liquid nitrogen, chemotherapy or immunotherapy.
I do Mohs surgery in my CLIA-approved office only on indicated facial, hand and genital lesions, do 99% of the repairs myself, do not charge a facility fee or an anesthesia fee, do not use physicians assistants, and have fair fees. I am up-to-date, just returned from the Closure Course given by the American Society for Mohs Surgery. A recent article in the New York Times is critical of some doctors who rip off patients with high fees, refer to plastic surgeons for repairs (who use anesthesiologists and work in hospital settings). I do not do that.
New discovery: Aldara cream (imiquimod), a topical immune enhancing agent, is used for 6 weeks pre-operatively to shrink large cancers in critical areas (tip of nose, ears, eyelids) so that less tissue has to be surgically removed, making the repair easier for the patient and Dr. Hughes. Dr. Hughes has seen dramatic pre-operative shrinking of tumor volume with this medication, allowing for easier surgical cure of the cancer. Another special technique that is newly popular and effective, originally promoted by Dr. Fred Mohs in the 1950’s, is the application of Mohs paste to a melanoma site (after the biopsy but before the complete excision). This creates immunostimulating inflammation and an increased survival rate.
Pregnancy: Using local lidocaine anesthesthia, surgical removal of skin cancer is safe during pregancy.
Mohs surgery requires special training both in frozen section microscopic interpretation and in the surgical technique for excising the cancer and then repairing the defect in a cosmetically elegant manner.
The American Society for Mohs Surgery is a non-profit professional medical society of over 700 dermatologists, pathologists, and Mohs technicians. Founded in 1990, the ASMS is dedicated to the highest quality patient care and education relative to Mohs surgery as a specialized surgical treatment for skin cancer. Dr. Hughes is a Fellow of the American Society for Mohs Surgery and was a speaker at the annual ASMS meeting in 2004. Contact Dr. Philip Hughes today for evaluation and treatment of any suspected skin cancer!
Mohs cancer surgery with laser scar resurfacing