Mohs Surgery

What is Mohs Micrographic Skin Cancer Surgery?

Mohs surgery is the technique of utilizing the power of the microscope to properly map out and examine skin cancers, so that they may be removed with the highest level of confidence. Mohs is named after Dr. Frederick Mohs at the University of Wisconsin, who developed the fundamentals and advocated its' use in treating skin cancers in the 1930's.

How effective is Mohs Surgery?

Mohs surgery is the most advanced, precise method of removing skin cancer. The Mohs technique has been shown to have the highest cure rate of non-melanoma skin cancers. This is especially important when treating tumors on the face, neck, and ear where incomplete tumor removal and recurrence can be devastating. Read this article about Charlotte Bradshaw who was diagnosed with basal cell carcinoma at the age of 39 and treated with Mohs micrographic skin cancer surgery.

What are the advantages of Mohs Surgery?

In addition to providing you with the highest cure rate possible, Mohs surgery results in the removal of as little normal skin as possible. Conventional surgery involves removing up to ¼ inch of the normal appearing skin around the skin cancer to increase the chances of cure. The immediate tissue processing and precise mapping done with Mohs surgery makes this unnecessary. This means that the defect (hole) left after removing the cancer is smaller and is easier to fix, leaving a smaller scar, and providing you with a better cosmetic outcome.

Why Choose a Fellowship Trained Mohs Surgeon?

Mohs micrographic skin cancer surgery has set a new standard in skin cancer treatment. An increasing number of physicians are performing Mohs surgery, which is now widely accepted as the most effective treatment for most types of skin cancer. However, not all Mohs surgeons receive the same level of training as our fellowship trained Mohs surgeons.

When it comes to your skin cancer treatment, you deserve no less than the best. Our Fellowship Trained Mohs Surgeons have achieved the highest degree of Mohs surgery qualification by completing an American College of Mohs Surgery (ACMS) approved fellowship. For you, this means peace of mind, knowing that you will receive superior quality and competency, as well as an optimal outcome.

During fellowship training, our Mohs surgeons studied and trained under the guidance of veteran Mohs College surgeons who have demonstrated expertise in Mohs surgery. A cornerstone of the ACMS fellowship training program is cultivating experience and judgment in each graduate. Since skin cancer occurs in a diversity of forms, degrees and locations, the program is set up to be thorough and stringent.

Our Mohs surgeons met the following requirements in completing their ACMS fellowship:

As ACMS graduates, our Mohs surgeons gained an uncommon level of exposure, including everything from challenging tumor locations to rare tumor pathology and complex wound reconstruction. You can rest assured that they have the training and experience to achieve the best outcome from your skin cancer treatment.

What do I need to do to prepare for the surgery?

If you normally take antibiotics prior to going to the dentist because you have an artificial joint less than 2 years old or have an artificial heart valve, you may need to take antibiotics before surgery. If you were not given a prescription for antibiotics, please call our staff. If you do not have an artificial joint or artificial heart valve, no antibiotics are required before your Mohs surgery. Please take any medications you normally take. If you are taking aspirin, warfarin, plavix, or heparin, please do not stop these medications before surgery. We ask that you avoid drinking alcohol for three days prior to surgery and for two days after.

Can I bring a companion to my appointment and what else should I bring?

This procedure can sometimes last several hours, with much of the time spent waiting for slides to be made and interpreted. Having someone come to your appointment with you is a good idea but not necessary. Your companion may come in the room and keep you company during the waiting periods. We also suggest that you bring along some reading material or a quiet activity that you could do while you wait.

There doesn't seem to be anything there anymore after the biopsy.

Sometimes after the biopsy, it looks as if the skin cancer went away. This is not the case. Normal looking skin just heals over it; the roots are still left behind and growing. Once you cut into the skin and examine it, there is still cancer there. If this is not treated, it will continue to grow and can become large. The tumor is almost always bigger than what one can see with the naked eye; that is why it is examined under the microscope. The surgery should still be done.

Will the surgery leave a scar?

Anytime you cut the skin, no matter who does it or how it is done, there may be some sort of scar. Of course, one of the major advantages of the Mohs surgery technique is that it minimizes the risk and extent of scars.

Will I have pain or bruising after the surgery?

Most patients do not experience pain following surgery. If any discomfort were to occur, we recommend that you take Tylenol. You may have some bruising around the wound. This will only last a few days if at all.

Will I have any limitations after surgery?

Some patients feel tired after the surgery due to the long day. We advise that you would take it easy for a few days, limiting any strenuous activities/exercise. You, of course, know how you are feeling and can adjust your activity level accordingly.

What is going to happen the day of surgery?

Arrival: After you check in with the receptionist, one of the Mohs assistants will greet you and bring you into the surgery room. Your companion may accompany you initially, but will have to move to the waiting room during each part of the surgery.

Preparation: Once in the surgery room, the Mohs assistant will be able to answer any questions you may have before the surgery and go over the consent form, take your pulse and blood pressure. We will be taking multiple measurements and pictures of the treatment site throughout the day. The Mohs team taking care of you will consist of the Mohs surgeon, two assistants and a histotechnologist. The Mohs surgeon will be in to greet you and answer any questions before starting.

Surgery: You will be positioned on the surgery table in a comfortable fashion. The area is cleaned with a disinfectant solution and a local anesthetic is injected to numb the area. At this time, you will notice a stinging or burning sensation that will last a few seconds. This will be the same feeling you had with the biopsy. Once the area is numb, a thin layer of tissue will be excised. Bleeding will then be stopped with an electric cautery. You will be able to hear a buzzing noise and this will have a distinct smell as it cauterizes the blood vessels. A dressing will then be applied and your companion will be allowed to rejoin you in the surgery room while the tissue layer is being processed and examined underneath the microscope. This part of the surgery is considered a stage, 2-4 stages is average. This of course, depends on the aggressiveness of the skin cancer and may take 10 or more stages in difficult cases. At each stage, additional anesthetic is injected. The area usually remains numb; however, these additional injections give minimal discomfort.

Waiting/Processing: You will spend most of your day waiting. While you are waiting, the tissue that was removed will be brought into the lab and begin to be processed. This will take approximately 30-45 minutes per stage. When the slides are done, the doctor will examine them and inform you of the findings.

Cosmetic Reconstruction: Your attending physician is trained in advanced cosmetic reconstruction after Mohs surgery and will do everything possible to give you the best cosmetic outcome, once the area is free of tumor.

Bandage Changes/Wound Care: A pressure bandage will be placed on the wound and will need to stay in place for 24-48 hours. You will be instructed on how and when to change your bandage and when to come back for suture removal at the time of your surgery.  
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"Dr. Maggiolino has the greatest sensitivity and kindness with his patients; it is very easy to place complete trust in him."
- Barb, Grafton patient

"Doctor did a great job explaining the process and did a beautiful job stitching up my wounds after the Mohs surgery."
- Dawn, Appleton patient

"Dr. Campbell and her staff at the De Pere clinic were great! They made me feel comfortable as possible. I appreciate all the effort!"
- Daniel, De Pere patient

"I have gladly recommended you to friends and family! I was completely satisfied!"
- Andy, Marinette patient

"I am very pleased with the results of my surgery, as I have a minimal scar and no pain."
- Patricia, Sturgeon Bay patient

"Everyone was very friendly. The staff was professional in their approach and bedside manner, explaining procedures, treatments and recommendations very thoroughly. I will definitely return!"
- Robert, Manitowoc patient

"I had a great experience and have already referred others."
- Tara, Green Bay patient
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