Mohs Micrographic Skin Cancer Surgery in Seattle
Mohs surgery is most commonly used for basal and squamous cell carcinomas, although it can be recommended for the eradication of other cancers such as melanoma. Cancers that are likely to recur or have already recurred are often treated using this technique because it is so thorough. High precision makes Mohs surgery ideal for the elimination of cancers in cosmetically and functionally critical areas such as the face (nose, eyelids, lips, hairline), hands, feet and genitals.
Mohs surgery involves the systematic removal and microscopic analysis of thin layers of tissue at the tumor site until the last traces of the cancer have been eliminated.
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The immediate and complete microscopic examination and evaluation of excised tissue is what differentiates Mohs surgery from other cancer removal procedures. Only cancerous tissue is removed, minimizing both post-operative wound size and the chance of recurrence.
Mohs physicians are highly trained to function as surgeon, pathologist and reconstructive surgeon during the cancer removal process. They work in offices equipped with appropriate surgical and laboratory facilities, and are supported by Mohs-trained nursing and technical staff.
As with any surgery, there are risks. There may be temporary or permanent numbness or muscle weakness in the area. Other possible complications include tenderness, itching, shooting pains, and need for further surgery if skin flaps or grafts fail.
Mohs Micrographic Surgery
Mohs micrographic surgery is state-of-the-art treatment for skin cancer. Developed by Frederic E. Mohs, M.D. in the 1930s, Mohs Micrographic Surgery has been refined into a highly precise, highly effective method that removes not only the visible skin cancer, but also any "roots" that may have extended beneath the skin surface. With cure rates up to 99%, the Mohs technique is the most precise method of tumor removal. Dr. Reichel trained for Mohs surgery at the University of Washington. She is certified by the American College of Mohs Surgery (ACMS) and is specially trained in surgery, pathology, and reconstruction.
Mohs micrographic surgery:
- offers the highest cure rate (up to 99%)
- has the lowest rate of cancer recurrence
- minimizes scarring
Mohs micrographic surgery has proven to be the most effective skin cancer treatment by combining the surgical removal of cancer with the immediate microscopic examination of the tumor and underlying diseased tissue. This process allows the surgeon to see beyond the visible disease and precisely identify and remove the entire tumor... and nothing but the tumor.
Mohs micrographic surgery procedure
After local anesthesia, Dr. Reichel excises the entire visible tumor and an additional very thin layer of surrounding normal skin. She creates a "map" or drawing of the removed tissue to use as a guide to the precise location of any remaining cancer cells. The tissue is then processed by a skilled pathology technician and Dr. Reichel examines the tissue under the microscope to see if any tumor "roots" are still present. This entire process is called a "layer", and takes about one hour to do.
If any of the sections still contain cancer roots (cells), your Mohs surgeon:
- returns to the specific area of the tumor site as indicated by the map;
- removes another thin "layer" of tissue only from the specific area within each section where cancer cells were detected; and,
- microscopically examines the newly removed tissue for additional cancer cells.
In most cases, after the cancer is gone, Dr. Reichel moves to "plastic-surgery" mode and the defect, or "hole" that is created is repaired with either sutures, or a skin graft. Dr. Reichel and her staff will discuss this with the patient before reconstruction is done. Mohs surgery is most commonly used for basal and squamous cell carcinomas, although it can be recommended for the eradication of other cancers such as melanoma or Merkel Cell carcinoma. Skin cancers that are likely to recur or have already recurred are often treated using this technique because it is so thorough. High precision makes Mohs surgery ideal for the elimination of cancers in cosmetically and functionally critical areas such as the face (nose, eyelids, lips, hairline), hands, feet and genitals.
What to expect from recovery after Mohs surgery
Mohs micrographic surgery is the most precise, and successful, surgical technique for removing skin cancer. With a cure rate of around 99%, and the lowest rates of cancer recurrence (95% success rate), you won’t need to worry about your cancer returning. But what about your scarring and recovery?
There will be some bruising and crusting of the wound for the first two to three weeks. The basic recovery of your wound will take from several days to several weeks, depending on the size, complexity of the incision closure, and the location. This is just the surface recovery, as complete healing of the surgical scar takes from 12-18 months.
During the early months after surgery, your wound will likely itch at times. It may also be numb, but feeling should return with time. Your scar will have a reddish appearance and the skin may actually contract and tighten. These are both temporary changes. Most scars initially are red and raised, but flatten and fade in six months to a year. You can gently massage the area beginning about one month after your surgery; this speeds the healing process.
Once healed, if you’re concerned about your scar, we have various cosmetic procedures that can lessen its appearance.
Mohs physicians are highly trained to function as cancer surgeon, pathologist and reconstructive surgeon during the cancer removal process. As with Dr. Reichel’s office, all Mohs surgery offices should be equipped with appropriate surgical and laboratory facilities on site. Support staff should include Mohs-trained nurses and pathology staff. Dr. Reichel has a certified Mohs laboratory where her Mohs Histotechnician processes and prepares the pathology specimens. Her nursing staff is trained in Mohs surgery, and is run by a head Mohs registered nurse. All reconstructions are performed in the AAAHC and Medicare certified ambulatory surgery facility.
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