Best Mohs Surgeon in San Francisco

Mohs surgery is recommended for:

• skin cancers in cosmetically sensitive areas of the body, where preserving as much of the normal skin as possible is paramount, such as the face, nose, lips, eyelids, ears, hands, feet, genital area

• skin cancers that recurred after previous treatment

• skin cancers with indistinct borders where the extent of the tumor cannot be determined with the naked eye

• skin cancers of large size that are not effectively curable with other treatment methods

Mohs surgery is a minor surgical procedure, performed on an outpatient basis in an office or ambulatory surgery setting. Upon arrival to the procedure room, the site of the biopsied skin cancer is identified by you, confirmed by your surgeon and assistants, marked with a skin pen, photographed for your medical record, and numbed by injection of an anesthetic under the skin.

A small layer of tissue around the cancer is then removed by your surgeon, after which minor bleeding in the skin is stopped using electric cautery, and a clean dressing is placed on the wound. This takes approximately 10-15 minutes.

The removed tissue is taken to the Mohs laboratory, where it is frozen, sliced onto microscope slides, and stained with chemicals to visualize the cells under the microscope. After this process, your surgeon will examine the tissue slides under the microscope, and create a map of any residual cancer. This way, the exact location of any residual cancer is determined and subsequently removed without having to remove any of the skin that appeared normal under the microscope. This process is called a “Mohs surgery stage” and takes about 40 minutes.

At this point, the surgeon returns to the wound, applies more anesthetic to the area to keep the area numb for any further stages and reconstruction of the wound, and removes additional cancer from around the wound using the microscopic map of the skin cancer. This process of searching under the microscope and removing all roots of the skin cancer is repeated until the entire skin cancer is removed.

Although some skin cancers are removed in one stage, the average skin cancer requires two stages for removal, with some cancers requiring several more stages to be completely removed. The total time of your visit will depend on how deep or wide your cancer is, and how many times this process must be repeated. The intent of this treatment is to remove the entire skin cancer, and to preserve any uninvolved skin. This often requires removal of the cancer in small, conservative layers where necessary.

When all the cancer is removed, the wound left by removal of the cancer is closed using a number of reconstructive surgery techniques, ranging from the straightforward to the advanced or complex.

Read more to find out more about reconstructive surgery.

Upon arrival to the clinic, you will be required to complete the check-in process for your appointment. You will be shown to a procedure room, where important aspects of your medical history, such as medications, allergies, will be reviewed. You will be asked to sign a consent form that will give us your permission to perform the procedure and to be photographed.

The site of the skin cancer will be identified by the surgeon, confirmed by you, and a photograph of the area to be operated upon will be taken. The skin will be cleaned with alcohol and then numbed with an injection of Lidocaine anesthetic.

A thin layer of skin at the site of the cancer is then removed with a scalpel. Any bleeding is stopped. The wound is then covered with a temporary bandage, after which you will wait for 30 to 60 minutes, during which the removed skin is processed by the Mohs laboratory, and looked at under the microscope by the Mohs surgeon to see if the entire cancer has been removed. This process takes approximately 30-60 minutes for basal cell and squamous cell carcinoma, and is longer for melanoma treated with Mohs Surgery, or for any cancer where a large piece of skin tissue is removed.

After the laboratory has completed the slide preparation process, the Mohs surgeon looks at the removed skin tissue under the microscope. If any tumor is left, the corresponding area is marked on a map (this map is used to tell us where the tumor still is on your skin), and the surgeon will remove further skin from the area where the cancer is still present. The process is then repeated as above. The average number of these cycles that need to be taken is two, although it could take more or less cuts to ensure that the entire cancer is removed

When all the cancer has been removed, the surgeon will stitch and bandage your wound. You will be given instructions for how to care for your wound at home, and what to expect during your recovery after Mohs Surgery. You will typically be seen for a follow-up visit between 1 to 4 weeks after Mohs Surgery.

Expect some swelling, bruising, and discomfort at the site of your surgery, which may last for a few days. These usually resolve with ice, rest, analgesic medications such as acetaminophen and ibuprofen after 1-3 days.