Mohs micrographic surgery is an advanced and highly specialized technique to remove skin cancer and is performed by Santa Barbara based dermatologist and dermasurgeon Keith Llewellyn MD.
How It HelpsMohs Micrographic 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 1930's 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.
What to ExpectMohs surgery is performed as an outpatient surgical procedure and local anesthesia is used so the patient is awake and comfortable throughout the procedure. The visible margins of the skin cancer are outlined with ink and the skin cancer is removed with a very small safety margin of what appears to be clinically normal skin. A temporary bandage is then placed on the patient who waits comfortably in the reception area while the tissue is processed immediately by a highly trained histopathologist and then read by Keith Llewellyn MD. The tissue is processed in a manner that allows for visualization of nearly 100% of the true margins of the surgical specimen. The tissue and the patient are marked like a map or clock with ink and carefully placed surgical nicks. If the doctor 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 surgical defect deeper or remove another full circle of tissue. Keith Llewellyn MD, 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. This process (called "stages") will repeat until the roots of the skin cancer have been completely removed and the margins of the removed skin tissue appear normal under the microscope. 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. In most cases the defect can be closed in a straight line, but skin flaps or skin grafts may be needed 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, a plastic surgeon may be enlisted 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. While highly refined, the Mohs technique can be time consuming and Aloe Dermatology advises all patients to expect to be in the office from early morning until early/mid afternoon, or an average of 3 hours.
How to PrepareMohs surgery is an outpatient procedure and typically does not require any preparation before the surgery. However, do keep in mind that the procedure is sometimes lengthy with quite a lot of time spent waiting comfortably in our reception area. We suggest bringing snacks, a good book, or tablet/computer to keep you occupied. Plan on spending 3 hours (sometimes longer or shorter) with us.
Post-Care InstructionsFollowing your Mohs surgery, a staff member will thoroughly review post-procedure care with you. We suggest you keep the site dry for the first 24 hours following your surgery. After 24 hours you may shower/wash the surgery site with gentle cleansers, however you may not submerge the site under water (i.e. swimming or bathing). Twice daily you should apply an antibiotic ointment (polysporin or neosporin) to the site and apply a new bandage. If further/special care is necessary, Keith Llewellyn MD or a medical assistant will review additional care instructions with you at the time of your surgery.
More Information About Mohs Surgery
Each skin cancer in a given individual, 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 often 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 our reception area (this typically takes 30-40 minutes per stage). As you will be in Dr. Keith Llewellyn’s 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 tablet and surf the web as well.
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.
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.
Note: This information is not intended to render medical advice on a particular case. To receive medical advice requires a visit with a medical physician. Keith Llewellyn MD in Santa Barbara is certified to the highest national standards to detect and treat skin cancer by the American Board of Dermatology. He is a fellow of the the American Society for Mohs Surgery, the American Society for Dermatologic Surgery, the American Academy of Dermatology and the Skin Cancer Foundation.