Mohs Micrographic Surgery
at Tulane University Medical Center
Alan T. Lewis,
M.D. - Director
Physician Referral Form - Click Here!
Treating Skin Cancer with Mohs Micrographic
Surgery
Mohs
micrographic surgery is a highly specialized outpatient procedure
which allows a physician to treat skin cancers. The technique,
created by Dr. Frederick Mohs, is as follows:
- A
local anesthetic (usually lidocaine) is injected around
the skin cancer.
- The
visible portion of the skin cancer is surgically removed.
- The
physician then removes a thin layer of tissue at the bed
of the cancer.
- The
entire undersurface and skin edges are then examined microscopically.
That tissue is dyed to distinguish between top and
bottom and left from right. A drawing is made so that the
physician can pinpoint any areas of tumor.
- Once
the tissue has been removed, it is sectioned into very thin
slices and examined under a microscope.
- After
examining the edges and underside of the removed tissue,
the physician outlines the exact location of any additional
areas of cancer. If more cancer is found, the procedure
is repeated in stages until the physician finds that no
cancer cells remain.
Why
Mohs Micrographic Surgery?
There are several reasons why a surgeon will recommend the
technique and a patient will opt to undergo Mohs micrographic
surgery.
Mohs
micrographic surgery allows for the highest chance of cure.
In fact, while some other techniques have only a 50 to 90
percent success rate, Mohs enjoys a 97 percent or higher success rate
in curing most skin cancers.
By using the microscope and the mapping technique, Mohs surgery
pinpoints the cancerous areas and removes those areas only.
By doing this, the exact location of skin cancer cells is
determined. This allows the physician to save as much healthy
tissue as possible.
Since Mohs surgery is so specialized, there are very few
medical centers in the United States which perform the
procedure.
Tulane University Medical Center has developed a Mohs Micrographic
Surgery Center, headed by Dr.
Alan T. Lewis.
Dr. Lewis is an Assistant Professor of Dermatology
at Tulane Medical School. He received specialized training
in
Mohs micrographic surgery and dermatologic surgery
by completing
an accredited Mohs fellowship at the Dermatologic SurgiCenter
in Philadelphia, PA. Dr. Lewis is a member of the American College of Mohs Micrographic Surgery and Cutaneous Oncology and is well versed in the treatment of all types of skin cancers. He is also a member of the American Academy of Dermatology and the American Society of Dermatologic Surgery.
Dr.
Lewis completed his dermatology residency at Baylor College of Medicine in Houston, TX.
Dr. Lewis received his medical degree from the Louisiana
State University Medical Center in New Orleans.
What
A Surgeon Needs To Know Before Surgery
Due
to the complex nature of Mohs micrographic surgery, it is
important for the surgeon to know as much about the skin cancer
as possible. That is why preoperative visits are so vital.
They allow the physician to examine the cancer, obtain a medical
history and determine whether Mohs surgery is the proper procedure.
It also allows the surgeon to determine and plan the required reconstructive procedure that you will need after your skin cancer is removed. Preoperative visits also give the patient the opportunity
to learn as much about the technique as possible.
When a patient has been referred to us for surgery, a biopsy
has usually been performed. We will review the pathology report
and the biopsy, noting what type of skin cancer you have.
If a biopsy has not been performed, we will take a small piece
of the lesion at the time of the preoperative visit.
A
Patient Prepares For Surgery
With
Mohs micrographic surgery, there are usually no complicated
pre-surgery procedures necessary. A patient should get a full
night's sleep the night before Mohs surgery, eat a light breakfast,
unless told to do otherwise, and be prepared to spend the
entire day undergoing Mohs surgery.
Patients, however, should not take any aspirin products for
at least two weeks before the surgery. In addition, other
types of pain medicines such as Advil, Motrin or other non-steroidal
anti-inflammatory agents, should not be taken within a week
before surgery. Plain Tylenol is fine to take if a pain medicine
is needed. A patient should not drink any alcoholic beverages
three to four days before surgery. If you are taking blood thinners, such as aspirin, Plavix or warfarin (Coumadin) due to a history of heart disease, stroke or atherosclerotic disease, you should not discontinue your blood thinners. You should discuss this with Dr. Lewis at the time of your pre-operative visit.
What
A Patient Should Expect During Surgery
As
noted before, the surgery is an "all-day" technique. As a
result, the procedure is scheduled early in the day. Once the patient arrives, he or she
is prepared for surgery.
The anesthetic is administered and the tissues are removed.
Before the patient leaves the room, the area is bandaged.
The tissue is then taken to our laboratory while the patient
waits in the appropriate area. The laboratory portion of the process can range from
30 minutes to an hour or more.
If the removed tissue is found to still contain skin cancer,
then the procedure will be repeated as soon as possible. In
fact, several excisions and microscopic essays may be done
in one day. Rarely is it necessary for the patient to return
the next day for further surgery.
The technique is strictly outpatient. However, on rare occasions,
patients must be hospitalized after treatment.
Treating
The Area Once Surgery Is Complete
Once
the cancer has been removed, there are several options available
regarding treatment. These methods include:
- Closing
the area with stitches
- Allowing
the area to heal by itself
- Closing
the area with a skin graft or flap
Recovery
Following Surgery
Following
the surgery and during the recovery period, patients will feel
some tightness or other sensations around the area of the
incision. As the area heals, the patient will experience less
and less discomfort. Skin cancers can affect nerves, and nerves
can be damaged by the cancer surgery. It may be several years
before total sensation or function is restored. In some rare cases,
however, complete nerve function may never return.
Most patients do not complain of severe pain. Some, however,
do experience some slight discomfort. If this occurs, the
patient should take two Tylenol tablets every four hours.
Again, aspirin products and any compound containing Ibuprofen
should be avoided. Use of alcohol or nicotine products is not recommended for at least one week after your surgery.
Of course, scarring occurs after every surgery, but because
the Mohs surgeon only removes the cancerous tissue, scarring
is kept at a minimum. If the post operative defect is extremely extensive, we work
with the referring physician and the patient to suggest cosmetic
surgical options.
Patient's
Lifestyle Following Surgery
Once
a patient has been given a clean bill of health, he or she
should be able to live a normal, healthy lifestyle. However,
direct sunlight should be avoided.
If exposure to the sun is unavoidable, a sunscreen with a
sun protection factor (SPF) of at least 15 should be liberally
applied to all exposed skin, including the tops of the ears.
Surgery
Follow-Up
The
surgeon or referring physician will need to observe the patient
for five years after the area has healed. The patient should
return for observation in four to six weeks, six months, and
annually thereafter. This is usually done by the physician who referred you for the Mohs procedure. Research has shown that if there is a
recurrence of cancer, it usually will be within the first
year following the surgery.
For
Further Information
If
you have any questions or need further information on
any
aspect of Mohs micrographic surgery, please contact Dr.
Alan Lewis at (504) 988-5800 or (504) 988-2324. We
will be happy to answer any of your questions.
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