Who performs the procedure?

Mohs surgery is performed by doctors who are specially trained to fulfill three roles:

1. as the surgeon who removes the cancerous tissue

2. as the pathologist who analyzes the lab specimens

3. as the surgeon who closes or reconstructs the wound

Beaches Dermatology's Board Certified Mohs surgeon, Dr. Darrell Fader, is an esteemed Fellow in the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Dr. Fader is also a dedicated member of the American Academy of Dermatology, as well as the Seattle Dermatologic Society and the Florida Medical Association. His extensive training and active participation in these organizations highlight his commitment to providing exceptional care in the field of dermatology.

Advantages of Mohs surgery

Efficient, cost-effective treatment

• Single-visit outpatient surgery

• Local anesthesia

• Lab work done on-site

Precise results

• Physician examines 100% of tumor margins

• Spares healthy tissue

• Leaves the smallest scar possible

The highest cure rate

• Up to 99% for a skin cancer that has not been treated before

• Up to 94% for a skin cancer that has recurred after previous treatment

What happens during Mohs surgery

The procedure is done in stages, all in one visit, while you are in our waiting area between each stage. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. The doctor repeats this process until no cancer cells remain.

Step 1: Top layer removal

Using a scalpel, the surgeon removes a thin layer of visible cancerous tissue. Some skin cancers may be “the tip of the iceberg,” meaning they have roots or extensions that aren’t visible from the surface. The lab analysis, which comes next, will determine that. Your wound is bandaged temporarily and you can relax while the lab work begins.

Step 2: Microscopic examination

The surgeon cuts the tissue into sections, color codes them with dyes and draws a map of the surgical site. In the lab, a technician freezes the divided tissue, then cuts very thin horizontal slices like a layer cake. The slices are placed on microscope slides, stained and covered. This meticulous process takes time. Using a microscope, the surgeon examines all the edges and underside of the tissue on the slides and, if any cancer cells remain, marks their location on the map. The physician then lets you know whether you need another layer of tissue removed.

Step 3: Second layer removal

Back in the operating room, the surgeon injects more anesthesia if needed and removes another layer of skin, precisely where the cancer cells remain, based on the map. Then, while you wait, the lab work begins again. This entire process is repeated as many times as needed until there are no more cancer cells.

Step 4: Wound repair

Once the site is clear of all cancer cells, the wound may be left open to heal or the surgeon may close it with stitches. This depends on its size and location. In some cases, a wound may need reconstruction with a skin flap, where neighboring tissue is moved into the wound, or possibly a skin graft. In some cases, your Mohs surgeon may coordinate the repair of your wound with another specialist such as a plastic surgeon, oculoplastic surgeon or hand surgeon. In most instances, however, the Mohs surgeon will repair the wound immediately after obtaining clear margins.