All about Mohs! In Dr. Gillen's words.

For the record, it’s Mohs. Not an acronym. Mohs. Named for Frederick Mohs, a surgeon who pioneered the technique. It is a surgical method in which the smallest amount of normal skin is removed while still ensuring that the cancer is gone, instead of taking a larger “standard” margin. Because skin cancer commonly occurs on what I like to call ‘high-end real estate’ like the face and scalp where there is not a lot of wiggle room, or extra skin, it is ideal for these sites. 

In our office, it is Dr. Gillen who performs Mohs. Here’s what he has to say about it: 

Me: "How many years of training did it take for you to be a mohs surgeon?"
Dr. Gillen: "After undergraduate studies and medical school I did a one year internship in internal medicine, a three year residency in dermatology and a one year fellowship in Mohs and reconstructive surgery."

So 13 years after high school.

Me: "Are Mohs surgeons board certified? Are all of them? How hard is this?"
Dr. Gillen: "Not all Mohs surgeons are board certified, nor are all of them fellowship trained. This is an important distinction. I am both.”

‘Nough said...Or not.

Dr. Gillen: "It’s important to note that fellowship-trained means that the surgeon has completed the additional year of training after residency during which they perform at least 600 cases of Mohs surgery while supervised by their fellowhip director. Fellowship is NOT required to perform Mohs surgery, but is recommended as it ensures that the surgeon has an adequate number of supervised cases during their training so that they are proficient with slide analysis and reconstructive techniques. Board certification is also NOT required to perform Mohs surgery, however the certification exam is recognized by the American Board of Dermatology as evidence of proficiency in the knowledge areas necessary to practice Mohs surgery effectively and safely. Patients should be aware of what board certification and fellowship training mean so they have a good idea of how their Mohs surgeon has been trained."

TLDR: Board-certified and fellowship-trained are not necessary but important. Make sure you know your surgeon's credentials before they cut on your face.

Me: "What do you want people to do before they come to the office for surgery? Any advice for your patients?"
Dr. Gillen: “Watch the movie on our website! Get some sleep. Eat a good breakfast. And try to avoid excessive alcohol intake for a day or two prior to surgery.” 

For reference, the movie: https://www.absolutedermva.com/services/mohs-surgery

Me: "What are the biggest misconceptions about Mohs?"
Dr. Gillen: “The patient thinks they will be coming in to have a piece of skin shaved off. Like their biopsy. Over and over. Until the margins are clear. This is not the case. Instead of shaving a very thin piece of skin as was done during their biopsy, it is a procedure involving a scalpel used to cut the skin, usually to the fat below the dermis. Once the skin cancer is removed, there is a defect [or hole] that then needs to be repaired.” 

This is the tricky part. Dr. Gillen does not just make holes. If the repair is done poorly, you may not look normal when the surgery is over.

Dr. Gillen: “This is done with sutures and usually involves lengthening the incision in order to provide a more cosmetically appealing scar.” [One that lies flat and is hidden well in the patient’s natural skin lines.]  “Also. There may be significant bruising and swelling around the surgical site in the postoperative period.” [In other words, don’t plan to do this the day before a wedding.] “This will resolve on its own with time.” 

Me: "What would you like patients to know before they come to the office?"
Dr. Gillen: "While the total operative time may be relatively short, there is a significant amount of time waiting for tissue processing. This is the step that happens in the lab and is how I assure that there is no skin cancer remaining on your body. This is the most important step and it is worth waiting for. It is also important to know that this happens for every stage if multiple stages are required.”

...bring a snack and a book and a blanket. 

Me: "What are the most common complications you see?"
Dr. Gillen: “Bleeding is the most common complication. The risk for bleeding is highest in the first 48 hours or so after surgery. This is why it is so important for patients to follow their postoperative instructions, which typically recommend ‘taking it easy,’ or avoiding things like vigorous exercise or manual labor.”

Doctor's orders: no yard work, no hanging decorations, definitely no exercise, no cooking, no cleaning. (That last bit might be a stretch).

Me: "Tell us your most gruesome stories."
Dr. Gillen: "These are not really appropriate to post on the blog, Tricia.”

Boooooring.

So there you have it. Be prepared for a potentially long day with short bursts of action and
some waiting. The procedure is more involved than the biopsy that was taken to diagnose your cancer as it is intended to remove all of the cancer. And then repair the skin, paying attention to detail to preserve your normal anatomy as much as possible.

Watch the movie, ask questions before your visit, please come on time with a fully belly and bag of snacks and maybe a book. We will be with you every step of theway and make you as comfortable as possible. We work as a team and we all love our work with you, the patient, our priority. We are honored to be involved in your care!

Author

Patricia O'Connor, MD Board Certified Dermatologist