Mohs Surgery

Mohs Surgery

Mohs Surgery in Santa Barbara, CA

Mohs micrographic surgery is an advanced and highly specialized technique to remove skin cancer. Dr. Keith Llewellyn performs Mohs surgery for men and women in Santa Barbara, Ventura, Solvang, Santa Maria, Santa Ynez, and the surrounding areas of California.

What is Mohs Surgery?

Mohs surgery offers the highest potential cure rates for skin cancer while preserving as much normal tissue as possible. This surgical technique was originally developed by Dr. Frederic Mohs in the 1930s and, over the years, has become even more refined. Mohs surgeons are skilled not only in Mohs surgery, but also dermatology, dermatopathology, dermatologic surgery, and reconstructive surgery.

Mohs surgery is performed in Dr. Keith Llewellyn’s Santa Barbara office as an outpatient surgical procedure. Local anesthesia is used so the patient is awake and comfortable during the procedure. The visible margins of the skin cancer are outlined with ink and then the skin cancer is removed with a very small safety margin of what appears to be clinically normal skin. A bandage is placed on the patient who then relaxes in the reception area while the tissue is immediately processed in the office. The cancerous tissue that is removed is processed by a highly trained histopathologist and then examined by the Mohs surgeon, Keith Llewellyn MD, while you are waiting. The tissue is processed in a manner that allows for visualization of nearly 100% of the true margins of the surgical specimen. Additionally, the tissue and the patient are marked like a map or clock with ink and carefully placed surgical nicks. If the Mohs surgeon, Keith Llewellyn MD, looks under the microscope and sees that the skin cancer is present around the 3 o’clock margin, the patient will be brought back to the surgical suite again for the removal of an additional small arc of tissue around the 3 o’clock area. In this example, the Mohs surgeon does not make the whole hole deeper or remove another full circle of tissue. The Mohs surgeon, guided by the microscopic examination of the tissue and careful mapping of the skin cancer, removes only the tissue that is affected by skin cancer and strives to preserve as much normal skin as possible. This next piece of tissue is processed and mapped in a similar manner. Keith Llewellyn MD, your Mohs surgeon, will repeat this process (called “stages”) until the roots of the skin cancer have been completely removed and the margins of the removed skin tissue appear normal under the microscope.

How Much Does Treatment for Mohs Surgery Cost?

Cost can be discussed during your office visit. Cost will vary depending on how many Mohs stages are required to remove your cancer and what type of repair will be needed to best reconstruct the resulting defect.   If we are providers for your insurance, we can bill your insurance for most medical problems and surgical procedures. If you are self pay or we do not accept your insurance, we can provide you with a quote for an initial consultative office visit cost over the phone prior to your appointment. This quote, however, does not include any procedures that may be advised and performed during your visit. See our financial policy for additional information. Our payment options include cash and major credit cards, and you can learn more on our financing page.

What Are the Benefits of Treatment for Mohs Surgery?

Mohs surgery is an advanced, precise surgical technique that offers the highest possible cure rate for skin cancer while also preserving normal tissue.

Am I a Candidate for Mohs Surgery Treatment?

Mohs surgery is not performed on every skin cancer. It is typically reserved for skin cancers on cosmetically sensitive areas (i.e. face, ears, nose, lip) and areas where tissue preservation is of functional importance (fingers for instance). Mohs surgery is also used for recurrent skin cancers, skin cancers incompletely removed by a previous excision, large skin cancers, skin cancers with poorly defined clinical borders, skin cancers in certain high risk anatomic areas and aggressive skin cancers.  Once you are diagnosed with skin cancer, Dr. Llewellyn can discuss your treatment options and their risks and benefits with you to determine if Mohs surgery is the best option for removing your skin cancer.

What Should I Expect from Mohs Surgery Treatment?

Mohs surgery is an advanced, precise surgical technique that offers the highest possible cure rate for skin cancer while also preserving normal tissue. It is, however, time consuming. Dr. Llewellyn advises his patients to plan to be in his Santa Barbara office from the morning to the early afternoon. Obviously, if your skin cancer is removed with the first one or two stages, you will be going home more quickly. The average time duration of Mohs surgery for Dr. Keith Llewellyn’s patients is about 3 hours. Each skin cancer in a given individual, however, is unpredictable. Sometimes, the skin cancer that you see on the surface of the skin represents the full extent of the tumor. In these cases, it is fully removed on the first stage of Mohs surgery. Other times, the skin cancer you see on the surface of the skin may represent the tip of an iceberg and it has roots under the skin that extend far from the clinically visible skin cancer. In these cases, it may take several stages to remove the skin cancer. Most of your time during Mohs surgery is spent comfortably awaiting the results of your tissue processing in the reception area (this typically takes 30-40 minutes per stage). As you will be in our office for some time, eat a good breakfast, bring snacks and a good book. Aloe Dermatology also provides Wi-Fi, so you could bring your lap top or iPad and surf the web as well.

Once the skin cancer is removed, a defect will be present. Keith Llewellyn MD repairs most of these defects the same day as your Mohs surgery. Usually the defect can be closed in a straight line, but skin flaps or skin grafts may need to be performed to attain a superior cosmetic and functional repair. Stitches are usually in place for one week and then removed. Occasionally, in particularly challenging or large defects, Dr. Keith Llewellyn may enlist the help of a Santa Barbara plastic surgeon to repair the defect created by removal of your skin cancer. This is usually arranged ahead of time so that your surgical repair can be done the same day as your Mohs surgery.  Sometimes the repair may need to be scheduled for the following day.

Not too long ago, Mohs micrographic surgery was only available to patients in large university settings. Today, dermatologist and dermasurgeon Keith Llewellyn MD can perform Mohs micrographic surgery on your skin cancer right here in Santa Barbara in a pleasant, nearby outpatient setting.

Mohs surgery is considered the “gold standard” for skin cancer removal. Aloe Dermatology offers Mohs surgery for men and women in Santa Barbara, Ventura, Solvang, Santa Maria, Santa Ynez, and the surrounding areas of California. Contact us today to schedule a consultation.