MOHS CANCER SURGERY
WHAT IS MOHS SURGERY?
OUR DOCTORS ARE ACMS MEMBERS
Dr. Douglas Fife, Dr. Mac Machan, and Dr. Steve Peine are few of only a few Mohs micrographic surgeons in the Las Vegas and St. George areas who are eligible for membership in the American College of Mohs Surgery (ACMS). All members of the ACMS were required to complete a one-year fellowship in Mohs micrographic surgery after Dermatology Residency, in which they received intensive training in surgical removal and reconstruction of difficult skin cancers on the face.
We are also currently the only center in Las Vegas & St. George performing Mohs surgery for Melanoma with same-day immunostaining in order to achieve the highest possible local cure rate. We are routinely performing MART-1 immunostains for both invasive melanoma and melanoma in-situ. The combination of Mohs surgery with immunostaining can provide a great benefit to patients who receive same-day histologic confirmation of tumor clearance and reconstruction during the same visit.
FREQUENTLY ASKED QUESTIONS
If you take coumadin, please have a routine coagulation study (PT/INR) drawn within 1 week of your surgery day. Have the results faxed to Vivida (702) 933-1444.
The thought of undergoing surgery for skin cancer produces anxiety in many patients. One of the main goals of Vivida Dermatology is to provide the best care and maximum comfort to our patients. We do that by educating our clients about the entire procedure and our vast experience in the same type of skin cancer surgery, so that the patient understands fully that they are in good hands. In order to help you understand the process of Mohs surgery and prepare for your day, please read the information below. In addition, you can visit our testimonials page to read about the experiences of other patients.
YOUR MOHS SURGERY DAY
Please arrive 15 minutes early prior to your appointment time to check in (or 30 minutes if it is your first time visiting the office in order to complete paperwork). You will be escorted to a surgery room by nursing staff, who will briefly review your medical history and cleanse the surgical area.
One of our providers will then meet you, explain the procedure, and answer any questions. The visible skin cancer will be circled with a marking pen and a local anesthetic will be injected. The cancer and a very small amount of surrounding skin will be removed with a scalpel. Any bleeding will be stopped by cautery or pressure, and a temporary dressing will be placed by the nursing staff, who will then escort you to a waiting area.
The specimen is carefully oriented, marked with colored dye. A technician takes the tissue, freezes it, cuts it in thin slices, places it on slides, and stains it for microscopic evaluation. Your doctor will then carefully examines the slides under the microscope, checking the edges of each piece of skin for residual skin cancer. The entire process of processing the tissue and reading the slide usually takes around 1 hour.
If any tumor is still present at the edges, you are brought back to the surgery room and a second stage of surgery is performed to remove the cancer only in the specific area where it still remains. This process continues until all of the cancer has been removed. Usually 1-3 stages of Mohs are required to clear a tumor, but occasionally more stages are required (up to 7-8). The entire surgery day may last from a few hours to the entire day.
When all of the cancer has been removed, your doctor will discuss all the options for repairing your wound, which either performed the same day or is postponed to a later date. Options for wound repair include:
- Simple side-to-side repair (also called primary closure or linear repair)
- Skin flap (a local flap of skin is brought in from the side of the wound to fill it in)
- Skin graft (skin is harvested from another site and placed to cover the wound)
- Occasionally allowing the wound to heal on its own provides the best appearance