Mohs

“1 IN 5 AMERICANS WILL DEVELOP SKIN CANCER IN THEIR LIFETIME”

What Can I Expect After Mohs Micrographic Surgery?

Following your surgery, we will discuss postoperative care with you and give you detailed written instructions on the care of your wound. You will leave with a compression bandage over the operative site that will stay in place for at least 48 hours. Swelling and bruising are common following Mohs surgery. A black eye is common with surgery around the eye or on the forehead and can be reduced by sleeping with your head elevated and using an ice pack. You should plan on wearing a bandage and avoiding strenuous physical activity for several weeks. Most patients experience minimal discomfort that responds to acetaminophen. You may experience tightness or tingling in the area of the surgery. Complete healing of the surgical scar takes over 12-18 months. Gentle massage of the area starting 1 month after the surgery will speed the healing process.

If you have sutures, you will need to return for suture removal. You may also need to return within one to three months after the surgery to ensure that the healing process is progressing smoothly.

About Our Staff and Dr. Kelley Pagliai Redbord

Our Mohs micrographic surgery unit is staffed by a team that includes a Mohs micrographic surgeon, surgical technicians, laboratory histotechnicians, and office staff who are here to serve you.

Dr. Kelley Pagliai Redbord is a board-certified dermatologist who specializes in Mohs micrographic surgery, skin cancer, and dermatologic surgery. Dr. Redbord, born and raised in Rockville, Maryland, received her Bachelor of Science degree at Duke University where she graduated cum laude and her medical degree from Johns Hopkins School of Medicine. After completing her dermatology residency as chief resident at the University of Cincinnati, Dr. Redbord completed a fellowship in Mohs Micrographic Surgery and Procedural Dermatology at the Laser and Skin Surgery Center of Indiana under the mentorship of Dr. C. William Hanke. Dr. Redbord is a member of the American Academy of Dermatology, the American College of Mohs Surgery, and the American Society for Dermatologic Surgery. She has presented original research at local and national conferences and written many articles on dermatology and dermatologic surgery. When Dr. Redbord is not practicing dermatology you can probably find her running. Dr. Redbord has completed 27 marathons and counting.

“MOHS HAS THE HIGHEST CURE RATE OF ANY TREATMENT OF SKIN CANCER”

MOHS MICROGRAPHIC SURGERY INFORMATION

WELCOME TO INTEGRATED DERMATOLOGY OF FAIRFAX

We are pleased that you have chosen our office for your surgical care. Our goal is to provide you with the highest quality care for the treatment of your skin cancer. You have been scheduled for treatment with Mohs micrographic surgery.

What is Mohs Micrographic Surgery?

Mohs micrographic surgery (“Mohs surgery”), named after Dr. Frederic Mohs who developed the technique in the 1940’s, is a precise treatment for skin cancer in which cancerous cells are removed in stages, one tissue layer at a time. A skin cancer often grows downward and outward into the skin like the roots of a tree. These “roots” are not visible with the naked eye, but can be seen under a microscope. Once a tissue layer is removed, the edges are marked with specially colored dyes, and a map of the specimen is created. The tissue is then processed onto microscope slides and carefully examined under the microscope by our Mohs surgeon, Dr. Kelley Redbord. When cancer cells are seen, an additional tissue layer is removed only in areas where the cancer cells are still present, leaving normal skin intact. The entire process is repeated until no tumor is found. This allows Dr. Redbord to save as much healthy skin as possible.

Mohs surgery allows for the selective and complete removal of the skin cancer while preserving as much normal tissue as is possible. Mohs surgery is useful for large tumors, tumors with unclear borders or extensive roots, aggressive tumors, tumors near vital structures, and tumors where other forms of treatments have failed. Mohs surgery is safe, reliable, and has a significantly higher cure rate than any other available treatment. No treatment can guarantee 100% chance of cure, but with Mohs surgery the cure rate for new basal cell and squamous cell carcinomas exceeds 98%.

Mohs surgery is done as a same-day outpatient surgical procedure that eliminates the need for general anesthesia, and operating room or hospital fees. Mohs surgery is performed by a physician who is both the surgeon and the pathologist and has received specialized training and certification in this technique and reconstruction.

Not all skin cancers require Mohs surgery. Skin cancer can be treated with electrodessication and curettage, cryosurgery, standard surgical excision, radiation therapy, topical immunomodulating agents, and photodynamic therapy. Your doctor has referred you for Mohs surgery based on special considerations regarding your skin cancer.

“SKIN CANCER ACCOUNTS FOR NEARLY 50% OF ALL CANCERS COMBINED”

What is Skin Cancer?

Cancer is an abnormal growth of cells at an uncontrolled rate. Left alone, cancerous cells will continue to grow and destroy surrounding normal tissue and can be potentially life threatening and disfiguring. The most common cancers that occur on the skin are basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. In general, basal cell carcinoma is the skin cancer type least likely to spread to other parts of the body. Squamous cell carcinoma tends not to spread, or metastasize, if treated early. However, if treatment is delayed or neglected, this skin cancer can spread to lymph nodes and other body areas. Malignant melanoma is a skin cancer that can be life threatening if not treated at its earliest stages. If untreated, melanoma has the greatest chance of spreading to other organs. Fortunately, this type of skin cancer is less common than basal and squamous cell carcinoma. Excessive exposure to sunlight is the single most important factor associated with developing skin cancers. Other factors, including genetics, radiation exposure and trauma can also contribute to the development of skin cancers.

Studies show that once you develop a skin cancer, there is an increased risk of developing others in the years ahead. For this reason, it is important for you to continue seeing your primary dermatologist at regularly scheduled intervals and to schedule an appointment if you are concerned about new or changing growths on your skin. The best way to minimize the risk of developing more skin cancers is to protect your skin from the sun’s damaging rays.

How Do I Prepare for the Day of Surgery?

1. The best preparation for Mohs micrographic surgery is a good night’s rest followed by a normal breakfast (this is not the type of surgery where you will need to have an empty stomach).

2. You should expect to spend the entire day with us. You may wish to pack a light lunch, snacks and/or beverages. You may also wish to bring a book or magazine to read or another quiet activity since there is waiting time between stages of surgery. Because the day may prove to be tiring, you can bring a companion to accompany you on the day of surgery.

3. Shower normally the night before or the morning of your appointment since your wound and bandage must remain dry for 48 hours after surgery. Do not apply perfume, aftershave, or cologne. Do not wear makeup or facial moisturizer if your skin cancer is on or near your face. Because you may leave with a bulky dressing, please wear loose clothing to facilitate undressing and redressing.

4. If you have been instructed to take antibiotics before dental procedures or surgery, take your first dose of antibiotic one hour before your appointment. If you do not have a prescription, please call us as soon as possible before your surgery date so that we may call in a prescription to your pharmacy.

5. You should take all of your daily medications as usual on the morning of your surgery. Additionally, if you are taking aspirin or prescription blood thinners (Coumadin/warfarin, plavix, etc) for a history of heart problems, stroke, blood clot, or other medical conditions, DO NOT discontinue unless specifically advised to do so by your prescribing physician.

6. Please do not take any aspirin, vitamin E, gingko, ginseng, garlic, fish oil, herbal supplements, or anti-inflammatory pain medications (such as ibuprofen, Advil, Motrin, Aleve, Nuprin, etc.) for two weeks prior to your surgery unless #5 applies to you. These medications cause thinning of the blood, which can result in increased bleeding and bruising. Tylenol (acetaminophen) does not contribute to increased bleeding and can be used for pain relief.

7. Alcohol use may increase bleeding and should be stopped for 3 days before and after surgery.

8. Smoking causes changes in the bloodstream that interfere with the process of normal wound healing. This can negatively affect the cosmetic outcome of your surgery and limit our options for repairing your wound. Please make every attempt to quit smoking for at least 2 days before and 2 weeks after surgery.

9. You will have restrictions on your activity for approximately 1-2 weeks after surgery. This includes avoidance of heavy lifting, bending at the waist, swimming and strenuous activity (i.e. golf, exercise, yard work, etc.)

What Happens on the Day of Surgery?

You should plan on spending the entire day with us. The area around the site of your skin cancer will be numbed with a local anesthetic. Once the area is numbed, a thin layer of tissue will be removed and any bleeding will be controlled. The tissue will be mapped, color-coded, and sent to our on-site Mohs laboratory to be processed onto microscope slides. A bandage will be placed over the wound, and you will return to the waiting area.

On average, it takes an hour for the slides to be prepared and studied. Occasionally, tissue requires special attention and may take longer for processing or examination. If cancer is still present, an additional layer, or stage, is taken. The entire process is repeated until no tumor cells are seen. Although there is no way to tell how many stages will be necessary to remove your cancer, most Mohs surgery cases are completed in two to three stages. Therefore, Mohs surgery is generally completed in one day. Occasionally, however, a tumor may be extensive enough to necessitate continuing surgery a second day.

Once the skin cancer has been cleared, Dr. Redbord will discuss your options with you on the best method for treating the wound created by the surgery. At this point, optimizing the wound healing and final cosmetic result of your surgery becomes our highest priority. The wound can be treated by letting the wound heal by itself, closing the wound side to side with stitches, or closing the wound with a skin flap or graft. Rarely, a consultation with a reconstructive surgeon may be necessary.

Step 1
Skin cancer may have roots which extend beyond the visible tumor.

Step 2
Dr. Redbord surgically removes the visible tumor.

Step 3
Dr. Redbord divides the skin into layers and ‘maps’ the layers to the surgical site, using reference marks on the skin.

Step 4
The lab processes the tissue, so Dr. Redbord can microscopically examine the undersurface and edges of every section.

Step 5
If any cancer cells remain, Dr. Redbord will ‘map’ the location. She precisely removes another layer where the cancer remains.

Step 6
The tissue examination and removal stop when there is no evidence of remaining cancer.

 

What are the Risks of Mohs Micrographic Surgery?

1. Mild bleeding or oozing at the surgical site is fairly common. If you experience bleeding, you should move to a seated position and apply constant pressure on a gauze pad over the bleeding point for 20 minutes (timed); do not lift up or release the pressure at all during that period of time. If bleeding persists after continued pressure for 20 minutes, remain seated and repeat the pressure for another 20 minutes with an ice pack. If this fails, call our office or call the phone numbers provided on your postoperative instructions.

2. There will be a scar. Mohs surgery will leave you with the smallest wound possible thus creating the best opportunity for optimal cosmetic results. Dr. Redbord is available for you throughout the healing process to discuss any concerns that arise.

3. Itching and redness around the wound can indicate an allergy to bandage materials such as tape adhesive or antibiotic ointment. If you experience itching or a rash on the rest of your body after you have started an oral antibiotic or pain medication, this may indicate a medication allergy. If this occurs, please discontinue the medication and immediately call our office.

4. The skin cancer may be larger and deeper than expected and the wound may be larger than envisioned. The skin cancer may be near vital structures such as the eyelids, nose, or lips. If the tumor involves these areas, it may result in cosmetic or functional distortion.

5. There is a small chance that your tumor will regrow after surgery particularly if it was treated before, if it is large, or was present for a long time.

6. Infection following surgery is uncommon. A small amount of drainage on the bandage is to be expected.

7. In most cases, patients experience little discomfort after Mohs surgery. Tylenol (acetaminophen) does not contribute to increased bleeding and can be used for discomfort. We request that you do not take aspirin or ibuprofen-containing drugs for pain control. Additional pain medication may be prescribed if needed.

8. It is common for the area around the surgery site to feel slightly numb to the touch. This numbness may persist for several months before returning to normal or near normal. In rare instances, the area can stay numb permanently. In addition, some areas may be sensitive to temperature changes (such as cold air) following surgery. This sensitivity improves with time.