Skin Cancer & Mohs Surgery

Southern Dermatology in Raleigh NC offers one of the most effective treatments for skin cancer–Mohs Surgery.  Skin cancer affects people of all ages, sizes and skin types. It is the most common form of cancer in the United States with more than one million skin cancers diagnosed annually. In fact, one in five Americans will develop skin cancer in the course of a lifetime and more than 20 Americans die each day from skin cancer, primarily melanoma. The survival rate for patients whose melanoma is detected early, before the tumor has penetrated the epidermis (outermost layer of the skin), is about 99 percent.

To promote prevention and early detection of skin cancer, you should schedule an appointment to have a thorough skin examination for skin cancer if you have any of the following:

  • New or changed growth
  • Family history of skin cancer
  • Personal history of skin cancer
  • History of blistering sunburns
  • History of exposure to ultraviolet rays from the sun, tanning beds or sun lamps
  • Numerous moles
  • Large, asymmetrical or unusual looking moles
  • Fair skin
  • The tendency to burn and freckle rather than tan
  • Immunosuppressive medications
 Mohs Surgery

Mohs Micrographic Surgery, developed in the 1930’s by Dr. Frederic Mohs at the University of Wisconsin, is the skin cancer treatment with the highest reported cure rate. This specialized and effective surgery for removing skin cancer is practiced globally and can be used for practically any type of skin cancer. Mohs surgery allows an immediate and thorough microscopic exam of the removed cancer to ensure that all skin cancer cells have been removed.

Many skin cancers can be much larger than expected under the skin than they appear from the surface because they may have “roots”. Especially in the case of recurring cancers, extensions may appear deep below the scar tissue, making it very hard to predict how much skin will be impacted. With Mohs surgery, these “roots” can be tracked and removed while the normal tissue is left intact.

Mohs Treatment

Mohs surgery is not appropriate for treating all skin cancers, and it is most effective for recurring skin cancers or cancers that are at high risk for recurring. Mohs surgery is also effective for cancer located on the face, extremities and genitals, where cosmetic or functional purposes require preservation of as much healthy tissue as possible.

Dr. Wilmoth and Dr. Challgren of Southern Dermatology have been trained in this highly specialized cancer treatment, and both are Fellows with the American Society for Mohs Surgery. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery.

Dr. WilmothGregory J. Wilmoth, MD

Mohs surgery is a highly effective treatment for certain types of skin cancer. It offers the highest cure rate among treatments for skin cancer and can be used for practically any type of skin cancer. It is an exacting procedure in which specially trained dermatologists perform both a surgical excision of the skin cancer and microscopic examination of the surgical margins to ensure that all skin cancer cells have been removed.

ChallgrenCloseEric D. Challgren, MD
Mohs surgery is performed in the offices of Southern Dermatology & Skin Cancer Center on an outpatient basis and under local anesthesia. Dr. Wilmoth and Dr. Challgren have been trained in this highly specialized cancer treatment and both are Fellows with the American Society for Mohs Surgery. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Please do not delay to call us at 919-782-2152 if you have any of the above mentioned risk factors.

Before & After

Examples of Dr. Wilmoth’s and Dr. Challgren’s Mohs Micrographic Surgery Results Before, During & After

Preparing for Mohs Surgery

If Mohs surgery is a good option for you, plan to provide us with a complete list of all your medications, including prescriptions, over-the-counter, vitamins and supplements. It is imperative that we are aware of any blood thinners, aspirins, aspirin substitutes, herbal medicines and other supplements to your diet. On some areas, Mohs surgery may impair your ability to operate a motor vehicle or other heavy machinery.

Most insurance companies cover the costs of Mohs surgery and any reconstruction that is needed. Our staff can help you determine if your insurer has any requirements you need to be aware of or if you should contact your insurance company directly about your coverage.

Most Mohs surgery cases involve up to three stages and less than four hours of time. However, you will be encouraged to reserve a full day for each surgical procedure in case the extent of the cancer’s “roots” warrants longer time in surgery and the removal of additional layers of cancer is needed.

The Southern Dermatology surgical team will discuss further with you how you should prepare for the day of surgery and answer any questions you may have regarding complications. If you experience any severe side effects or complications, please contact our office immediately!

The Mohs Surgical Procedure


Stage1

Stage 1: We clean, mark and inject the area to be treated with a local anesthetic. In just a few minutes, we remove the visible cancer along with a thin layer of additional tissue.


Stage2

STAGE 2: We cut the removed tissue into four sections, stain and mark it on a Mohs map diagram.


Stage2.5

We freeze the tissue on a cryostat and remove very thin slices from the edges and undersurface. We then place the slices on slides, stain them and examine them under the microscope. This can take more than an hour.



Stage2.5.5

We carefully examine the specimen and pinpoint all microscropic “roots” on the Mohs map diagram. If we find residual cancer on the specimen, we utilize the Mohs map to identify where to remove additional tissue. Additional tissue will only be removed when cancer is present.


Stage3

Stage 3: We repeat the process outlined above until no remaining cancerous areas are found within a tissue specimen.


Stage4

Stage 4: When there is no remaining cancer tumor under miscroscopic examination, we repair the surgical incision site.


Post-Surgical Expectations

After surgery, you may be able to allow your wound to heal without any further surgery needed for repair, or you may want to consider wound repair performed by the Mohs surgeon, the original referring doctor or another specialized surgeon depending on your case.

For small post-surgical wounds, we may be able to suture the sides near the incision to close it up. However, sometimes a skin graft or flap needs to be used where there is not enough tissue to stretch and cover the wound. Stitches will be used to hold a flap in position and provide immediate coverage. If a skin graft is needed, skin may be taken from the neck ear or over the collarbone and sewn into place, and the graft site will be either allowed to heal or closed with stitches. You also may choose to have “touch-up” procedures performed on any skin graft or flap to improve its appearance after healing.

Some patients experience bruising, swelling or minor bleeding around the incision area. There are also some potential complications associated with Mohs surgery, including temporary or permanent numbness in or around the incision, temporary or permanent weakness in a portion of the face when applicable, tenderness of the surgical area, intermittent itching or shooting pain, and additional repair needed to skin grafts and flaps used to cover the incision.

A scar will remain after Mohs surgery, but this type of surgery leaves one of the smallest known surgical defects and resultant scar. Many times, results are acceptable even after extensive surgery, and most scars remodel and improve over the six to twelve month period following surgery. There are many techniques you can choose for enhancing the scar area following surgery to elevate, smooth, or otherwise resurface the scar.

Our surgical team will give you detailed instructions on how to care for your surgical wound daily at home.

Videos

Dr. Wilmoth Mohs Surgery Overview

When does a patient need Mohs Surgery?

Cure rates for Mohs Surgery

What to look for in a Mohs surgeon

How long does Mohs Surgery take?

How long does it take to recover?

Possible complications

How much scarring should I expect?

Dr. Challgren – Mohs Overview

Skin Cancer Treatment Options