Procedural Expertise

Mohs Surgery

The most complete and effective way to remove skin cancers.

Discovered at the University of Wisconsin by Dr. Frederic Mohs, this surgical technique ensures that cancer is removed with just enough surrounding normal skin, all confirmed and double-checked with a microscope. Mohs surgery is a highly-specialized procedure during which the surgeon examines every surface of the removed skin under the microscope (“micrographic”) to make sure that no tumor cells are left on the patient. If there is an incomplete removal of a skin tumor, the surgeon simply goes back to the patient and delicately removes more skin at the surgical site, just where is needed.

All other methods of skin cancer treatments require a certain amount of ‘educated guessing’ how wide and deep to remove. With Mohs surgery, tissue is examined under the microscope after it is immediately processed and the tumor is mapped out so there is no need to guess the extent of the cancer, as with other surgical treatments.

This image depicts a typical removed specimen, containing an irregularly shaped skin tumor. This sample has tumor “tentacles” close to the edge of the specimen (around 7 to 10 o’ clock) on the top view. When looking at the removed specimen from the side, the tumor is also close to the deep edge. Thus, the Mohs surgeon will take more skin at these edges only and repeat the microscopic analysis.

As evidenced in Figure 1, a full 100% view of the skin depth and edges is why Mohs has the highest skin cancer cure rate available and can treat tumors that extend beyond standard margins for other specialties.

Mohs Surgery of Special Sites

Moreover, Dr. Ezaldein also specializes in high-risk Mohs surgery sites such as the lips, fingers and toes or genitalia. If done correctly, Mohs surgery can spare the amputation of fingers and toes, extensive lip, eyelid, and ear surgery, and even spare genitalia and sexual well-being. These are typically cases of skin cancer in special sites where every millimeter of skin counts. By obtaining a full microscopic view of the removed specimen, Mohs surgery is extraordinarily helpful in sparing additional skin from being removed or amputated. As always, Dr. Ezaldein specializes in skin reconstruction after Mohs surgery in areas where every stitch counts and must be placed perfectly.

Incompletely Removed Tumors and Recurrences

Sometimes removing a widely-accepted amount of normal skin around the tumor (“margin”) is not enough and can leave the tumor behind, leading to a bigger surgery down the road and a higher possibility of recurrence. In these scenarios, Dr. Ezaldein performs Mohs surgery with special techniques to completely and comprehensively evaluate every edge and surface of the removed skin specimens. Typically, these cases are more challenging and take longer because the surgeon wants to check, double-check, and triple-check that there is no more tumor left behind.

In short, Mohs surgery serves to assist the surgeon to “get it right” the first time, or should the cancer have recurred, be the definitive treatment so that it does not return again. It is a vastly more complete and thorough treatment experience than might otherwise be expected, especially compared to traditional skin surgery, radiation, topical formulations, or scraping and burning methods. 

Dr. Ezaldein welcomes any patient seeking an initial evaluation or secondary opinion about skin cancer surgery, complex facial reconstruction, surgical treatment of hidradenitis and follicular conditions, scar revisions, or repigmentation procedures for vitiligo. You are welcome to contact us for a consultation.