Mohs Micrographic Surgery performed by Dr. Michael S. Cohen and Dr. Sari B. Weinstein is a highly specialized treatment for the total removal of skin cancer. This method differs from all other methods of treating skin cancer by the use of Complete Microscopic Examination of all the tissues removed surgically as well as detailed mapping techniques to allow the surgeon to remove all the roots and extensions of the skin cancer.
The procedure begins after the skin is injected with a local anesthetic to make it completely numb. Then the visible cancer and a very thin layer of surrounding skin are removed with a scalpel, carefully mapped, and examined microscopically. If there is still cancer seen under the microscope, another very thin layer of skin is removed from that exact location. This may be repeated as often as necessary to completely remove the cancer.
About Dr. Mohs
Dr. Frederic Mohs invented the technique used today while he was a medical student doing research in the department of Zoology at the University of Wisconsin in the 1930’s. At that time, Dr. Mohs removed tumors with a chemo-surgical technique where patients would come in daily after the tissue was excised and subsequently examined on a pathological basis. In fact, there was one patient who needed to return to Dr. Mohs office for thirty days! As the process evolved, surgeons refined the technique and now excise the tumor, remove layers of tissue and examine the fresh tissue immediately. The normal treatment time has now been reduced to one visit and allows for immediate reconstruction of the wound.
The American College of Mohs Surgery was founded by Dr. Mohs in 1967. Currently, more than 60 training centers around the United States are recognized by the college for instruction in Mohs micrographic surgery. There are approximately 1200 physicians in the world who are members of the college.
To be accepted as members of the Mohs College, physicians must complete a residency in dermatology plus a one- or two-year fellowship program approved by the Mohs College that includes extensive training in reconstruction and pathology for a total of four to five years of specialized training. Currently, more than 50 training centers around the United States are recognized by the college for instruction in Mohs Micrographic Surgery. There are approximately only six hundred physicians in the world who are members of the Mohs College.
About Dr. Michael Cohen
Michael S. Cohen, MD has been a board certified dermatologist who has been in practice since 1994. He attended the six-year medical education program at Boston University School of Medicine. He performed his internship in internal medicine at Mount Sinai Hospital in New York City. He trained in dermatology at UCLA Medical Center in Los Angeles, California. He subsequently did his fellowship in Mohs Micrographic Surgery at Boston Medical Center.
Dr. Cohen specializes in Mohs Micrographic Surgery for the removal of facial skin cancers and has a particular interest in facial reconstruction. He has been a Fellow of the American College of Mohs Surgery since 1994. There are only 15 surgeons in Nassau County who are Fellows of the Mohs College.
Dr. Cohen performs approximately 2000 skin cancer surgeries a year and has performed nearly 40,000 surgeries in his career. He has lectured on a local and national level to dermatologists about skin cancer surgery and reconstruction. He has appeared on NBC TV News and has been profiled in WINS Radio as well as The New York Times Magazine. He has served as a Clinical Assistant Professor at Ronald O. Perelman Department of Dermatology at NYU School of Medicine since 1996.
Dr. Cohen is now a fellow of the American Society of Dermatologic Surgery, American Society of Laser Medicine and The American Academy of Dermatology. He serves as an attending physician at South Nassau Communities Hospital. You can visit his physician profile at www.mohscollege.org
By using these detailed techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed.
The result is:
- The removal of as little normal skin as possible
- The highest possibility for curing the cancer
What is the cure rate?
Using Mohs surgery, the percentage of cure is more than 99% for most skin cancers, even when other forms of treatment offer only a 50% chance of success if previous treatments have failed.
Is hospitalization necessary?
No. Mohs surgery is performed in our pleasant outpatient surgical suite, and patients return home the same day.
On the Day of Surgery
Your appointment will be scheduled early in the day. The area around the skin cancer is numbed as if it was before the initial biopsy. This will feel like a pinch but will not be painful because we use both refined micro-injectors and a local anesthetic solutions that causes very little stinging. The surgical procedure alone takes only 10-15 minutes. However, it takes a minimum of 30-60 minutes to prepare and microscopically examine the tissues. Several surgical stages and microscopic examinations may be required, and you will be asked to wait between stages. Although there is no way to tell before surgery how many stages will be necessary, most cancers are removed in three stages or less.
We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material to occupy your time while waiting for the microscopic slides to be processed and examined. Magazines as well as TV will be available in the waiting room area. We also provide coffee, tea and snacks.
The most difficult part of the procedure is waiting for the results of the surgery. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you make no other plans for the entire day that you are scheduled for surgery.
Will the surgery leave a scar?
Yes, any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we may choose:
- To leave the wound to heal by itself
- To repair the wound with stitches, or
- To reconstruct the wound with skin graft or flap
This decision is based on the safest method that will provide the best cosmetic and functional result.
Will I have pain or bruising after surgery?
Most patients do not complain of pain. If there is any discomfort, Tylenol is all that is usually necessary for relief. Avoid medications containing aspirin (see Preparing for Surgery below) as they may cause bleeding. You may have bruising around the wound, especially if the surgery is close to the eye.
Preparing for Surgery
Medical History: A day or two before your appointment, please complete the attached medical history form and bring it with you the day of surgery.
Medications: Continue any medications prescribed by your doctor. However, aspirin is a drug that may prolong bleeding. We ask that you avoid aspirin (including Anacin, Bufferin, Excedrin, Alka Seltzer, Percodan, Motrin, Advil and Naprosyn) for one week before surgery. If you are taking any blood thinners (Coumadin, Plavix) please call our office before scheduled surgery. In addition, alcohol will also promote bleeding, so avoid alcoholic beverages 24 hours before surgery.
Transportation: We suggest that you arrange to have a companion drive you to and from the doctor’s office. You may also be more comfortable with someone to keep you company in the waiting room.
Breakfast: The day of surgery, we suggest you eat your normal breakfast.
Be Prompt: Plan to arrive at least 15 minutes early so that a medical chart can be prepared.
After surgery, will I need to come back?
Usually one return visit is all that is needed to examine the healed surgical site or to remove stitches. Afterwards, you may return to your referring physician for routine checkups.
A follow-up period of five years for the treated cancer is essential. After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your referring physician at least once each year, not only to examine the treated skin cancer but also to check for new skin cancers.