Mohs Surgery in Mill Valley

Understanding Skin Cancer

Cancer is tissue that grows at an uncontrollable and unpredictable rate. The three main forms of skin cancer are basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Skin cancer begins in the uppermost layer of skin and grows inward, forming roots, and spreads horizontally along the surface. These extensions cannot be seen with the naked eye, so what is visible on the surface may be only the tip of the iceberg.

Basal and squamous cell carcinomas usually grow locally and rarely spread to distant parts of the body, but if not completely removed, they can invade and destroy surrounding structures. Melanoma can be life-threatening if not treated early. Excessive sun exposure is the single most important cause of skin cancer, and fair-skinned people are at highest risk. Heredity, X-rays, trauma, and certain chemicals can also contribute.

Treatment Options for Skin Cancer

Skin cancer can be treated in several ways, including surgical excision, curettage and electrodesiccation, radiation, cryosurgery, topical chemotherapy, and Mohs surgery. The best method depends on the cancer’s location, size, and prior treatment. Mohs surgery is preferred for cancers in cosmetically and functionally important areas, for large or aggressive tumors, and for cancers that have returned after previous treatment.

What Is Mohs Surgery?

Developed by Dr. Frederic Mohs at the University of Wisconsin, the technique was originally called chemosurgery because it used a chemical applied to the skin. The procedure has since been refined to eliminate the chemical while keeping its defining feature: microscopic controlled excision. This method is time-consuming and requires highly specialized training, but the large number of patients cured clearly demonstrates its success.

How Mohs Surgery Is Performed

Mohs surgery involves three steps: removing the visible portion of the cancer, surgically excising a thin layer of tissue, and examining that tissue under the microscope. Before examination, the tissue is marked with colored dyes to map its orientation, allowing Dr. Lowenstein to pinpoint the exact location of any remaining cancer. If more cancer is found, another layer is removed only from that precise area. This process traces the cancer to its roots, removing as little healthy tissue as possible.

How Effective Is Mohs Surgery?

Mohs surgery has a success rate of 97% to 99%, even when other treatments have failed. By comparison, other therapies often have only a 50% to 70% chance of curing skin cancers that have recurred after previous treatment. If your skin cancer has been treated several times before, that doesn’t mean your case is hopeless; it simply means prior methods didn’t remove every cancer cell. The systematic microscopic control of Mohs surgery cures almost all patients, even those with persistent cancers.

Your Consultation Visit

At your preoperative visit, Dr. Lowenstein examines your skin cancer, reviews your history, and determines whether Mohs surgery is the most suitable treatment. If you were referred to us, a biopsy and pathology report are usually already available; if not, we typically perform a quick biopsy at the first visit. All patients are photographed before treatment, after surgery, and after healing, and these photos become part of your medical record. Because of the high demand for Mohs surgery, we’ll schedule a mutually convenient surgery date.

Preparing for the Day of Surgery

Get a good night’s rest and eat a light breakfast. Take your usual medications unless instructed otherwise. Bring a book or something to do, since the procedure may take much of the day and you’ll spend time waiting while slides are prepared. We recommend bringing a companion and having someone available to drive you home. Mohs surgery is performed as an outpatient procedure in our office.

What to Expect During Surgery

Appointments are usually scheduled early in the day. Dr. Lowenstein numbs the area with a local anesthetic, so you should feel no more than slight discomfort. After a thin layer of tissue is removed and bleeding is controlled, your wound is dressed while the tissue is processed, which usually takes about an hour. If cancer cells remain, the procedure is repeated. Most patients need one or two stages and are finished by midday; it is rarely necessary to return the next day. If you need to stay longer, have a light lunch and avoid alcohol.

Reconstruction After Mohs Surgery

Once the cancer is completely removed, we decide how best to repair the wound. Options include closing it in a straight line with stitches, closing it with a skin flap or graft, or allowing it to heal on its own. Dr. Lowenstein’s advanced training in facial anatomy and reconstruction allows him to choose repairs that protect function and produce the most natural appearance possible. Any surgery leaves a scar, but Mohs surgery is designed to minimize it.

Recovery and Wound Care

Most patients don’t experience significant pain afterward, and acetaminophen is usually all that’s needed. You’ll receive detailed wound care instructions. Stitched wounds and flaps should be kept clean and dry for 48 hours, followed by daily cleaning and dressing changes. Graft dressings stay in place until your follow-up visit. Wounds left to heal on their own typically close in four to eight weeks with daily dressing changes. Mild redness and swelling are normal, especially around the eyes. If bleeding occurs, lie down and apply firm, continuous pressure over the bandage for 20 minutes without lifting it; if bleeding persists, call our office or go to the nearest emergency room. Severe itching with extensive redness may indicate a reaction to the tape and should be reported.

After Your Wound Heals

A feeling of tightness is normal and lessens over several months. If the tumor involved nerves, numbness may take a year or two to improve and occasionally remains permanent. The new skin is often red and sensitive to temperature at first, but this fades with time. Itching is common because new skin has fewer oil glands; plain petroleum jelly helps.

Long-Term Follow-Up and Sun Protection

Follow-up for at least five years is essential. Once you’ve had one skin cancer, there is about a 50% chance of developing another within five years, so we recommend a skin exam at least once a year for life. If a recurrence happens, it usually occurs within the first year. You don’t have to avoid the sun entirely, but protect yourself by applying SPF 30 or higher sunscreen about 15 minutes before going outdoors, including the tops of your ears, reapplying after swimming or sweating, and wearing a broad-brimmed hat and protective clothing. Most health insurance policies cover Mohs surgery, subject to your deductible and co-pay. If you have concerns about scarring, our scar treatments can help refine healed surgical scars. Learn more about our skin cancer services.

Mohs Surgery FAQs

Expert Mohs Surgery Close to Home

Trust your skin cancer treatment to a fellowship-trained Mohs surgeon at Aesthetic Dermatology And Skin Cancer, Inc.. Call (415) 383-5475 or request an appointment online today.

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