A diagnosis of skin cancer can be both overwhelming and frightening. Fortunately, there are very good treatment options for the vast majority of skin cancers (basal and squamous cell carcinomas). Discovered in the late 1930’s and popularized in the mid 1980’s, Mohs surgery is the gold standard for treating most skin cancers. With a cure rate of 97-99% for basal and squamous cell carcinomas, most patients can leave the procedure feeling reassured they are cancer free. How does it work? Board-certified and fellowship trained Mohs surgeon Dr. Nicole Vélez walks us through a “day in the life” of a typical Mohs patient at her office at Pittsburgh Skin.

What can a skin cancer patient expect from Mohs surgery?

“High quality, evidence-based dermatologic care in a warm and friendly environment” has always been the goal here at Pittsburgh Skin.When I meet a patient who will be having Mohs surgery, I’m first and foremost interested in educating them about skin cancer. Once you have had one skin cancer, you are higher risk for developing a second one. I spend a good deal of time explaining how to prevent skin cancer and also how to detect one early. I then review the process of Mohs surgery in detail so that the patient knows what to expect. We have a laboratory in our office where I examine the tissue under the microscope while the patient waits. I also discuss how we will likely repair the defect (or hole that remains once the cancer is removed). The expected recovery and wound care are important parts of the pre-operative counseling as well.

The first step when we get started is to numb the area with local anesthesia. This is done with a small needle and slowly. Most patients do not find this very painful. Once the cancerous site is numbed, I manually remove a thin layer of the visible cancerous tissue with a scalpel. I then send that tissue to be processed in our in-house Mohs laboratory, where a Pittsburgh Skin histotechnician freezes the tissue and makes slides that can be analyzed under the microscope. I review all of my patient’s slides and determine if any tumor cells are present at the margin. I can then return to my patient to accurately remove a second layer of tissue if needed, ensuring that absolutely no cancer remains at the conclusion of the procedure. Once I’m certain the margins are clear, I repair the defect considering the location and skin type as well as the best approach to ensure an excellent functional and cosmetic outcome.

As a single-visit outpatient surgery in most cases, I can send my Mohs patients home the same day with the comforting knowledge that their skin cancer has been fully removed. Mohs surgery is not indicated for all skin cancers. It is usually reserved for cancers on the head and neck or skin cancers at other sites that are large or high risk. It’s important to have a discussion with your dermatologist about the cancer, treatment options and what is best for you.

Interested in learning if you or someone you know might be a candidate for Mohs surgery? Give our office a call at 412-206-2966. Dr. Vélez would be happy to meet with you and answer any questions you may have.