Information for Patients
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, 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 so that guessing the extent of the cancer is eliminated. This is why Mohs has the highest skin cancer cure rate available and can treat tumors that extend beyond standard margins for other specialties.
No! Only skin cancers that conform to the American Academy of Dermatology’s Mohs Appropriate Use Criteria are surgically removed with Mohs surgery.
Several types of Mohs surgeons exist, but you should have the most highly-trained surgeons treat your cancers. Surgeons/Fellows of the American College of Mohs Surgery (ACMS) are required to completed rigorous ACGME-accredited extra training and board certification that is not required by other Mohs surgery societies. After completing years of dermatology training, an ACMS member is required to receive hands-on training in performing Mohs surgery by a highly-qualified instructor and attain a heavy volume of surgeries and a wide array of reconstructive cases. Other Mohs surgery organizations don’t match the strict requirements used by the American College of Mohs Surgery.
Several other types of treatments exist and many are highly successful for the majority of patients.
- Excisions ( surgical removal with standard margins) with immediate closure
- Curettage with Electrodesiccation (scraping and burning the lesion with an electric needle)
- Laser (heating and burning tissue)
- Topical and injectable chemotherapy (chemical destruction)
- Cryosurgery (freezing the lesion)
- Radiation therapy
For advanced tumors:
- Traditional Chemotherapy (Intravenous)
- Immunotherapy Agents (Checkpoint inhibitors)
- Targeted Agents (Cell signaling pathway inhibitors)
Factors such as tumor biology, size, location, and the previous treatment history all influence how and which treatments we choose. Here is a simplified chart from my mentor Dr. Richard Bennett for your reference:
|Mohs micrographic surgery|
Highest cure rate;
normal tissue spared.
|● Time consuming; expensive|
|Excision with closure||Fast||● May not remove all cancer, especially melanomas of the head and neck or previously-treated cancers.|
Excision and closure with
frozen sections in operating
Examines some tissue
● Does not examine all tissue removed.
● Need general anesthesia. Expensive.
|Fast; inexpensive||● Likely to leave deeper aspects of the tumor behind, especially if it was treated before|
● May cause additional cancer, not good for younger patients.
● Can cause delayed scarring.
● May need 10 or more treatment sessions
● May not treat all tumor
● May scar
● Superficial and unlikely to cure deeper roots
● Unlikely to cure cancer if
large (> 1 inch) or if on face
(5-Fluorouracil or interferon)
● Uncertain of long lasting cure at
● requires 9 separate injections on separate days
● expensive; patient gets flu symptoms
Yes. Most physical forms of skin treatment will leave a scar. However, Mohs surgery tends to minimize this as much as possible by removing only what is necessary. After the wound is healed you may wish to have the scar improved. After enough healing time, any scar can be further touched up and improved by a number of techniques. Time alone will improve all scars however and most scars will improve significantly given enough time.
Such instances are not hopeless cases and cancer-prone patients (from genetic disorders) are rare. Recurrent skin cancers mean that the methods used to treat you in the past were not effective to destroy or remove all skin cancer cells. Mohs surgery can completely remove skin cancer by its roots, curing almost all patients- even if they were treated unsuccessfully in the past.
Skin cancers have a natural tendency to grow and invade nearby structures. Growth rate is difficult to predict and can vary widely from patient to patient. Some skin cancers are more superficial than deep, while others will destroy important structures such as the eye, tear ducts, nose or lip. Occasionally skin cancers may be fatal.
The following list is meant to assist all patients prepare for an upcoming surgery with us:
- Continue your regular medications as usual but do not take any Aspirin or herbal supplements 10-14 days prior to your procedure, unless another doctor told you to always take your Aspirin.
- If you take blood thinners such as Coumadin, Xarelto, Eliquis, Brilinta or others, continue taking them at your normal doses
- If you drink alcohol, you may continue to drink alcohol as you normally would.
- If you smoke marijuana, please avoid smoking 1 week before the surgery.
- Please let us know if you have a history of artificial joint surgery or heart valve, heart murmurs, rheumatic fever as a child, pacemaker or defibrillator or if any doctor ever recommended you take antibiotics before surgery or teeth cleaning.
- If you are having Mohs micrographic surgery, expect to stay the whole day with us. You can bring your computer (we have Internet access) or other reading/work material to stay occupied. We provide lunch for our Mohs surgery patients, but feel free to bring your own food if you prefer (microwave not available).
- Some patients prefer bringing wireless earphones to listen to music or an audiobook during their surgery.
- Get a good night’s rest, a relaxing morning shower, and eat an energizing breakfast on the day of the procedure.
- Please do your best to be fifteen minutes early to the surgery appointment.
The following list is meant to assist nearly all patients who underwent surgery with us:
Out-of-town and International Patients
Dr. Ezaldein welcomes patients from all over the United States and the rest of the world. Whether you are traveling or local, Dr. Ezaldein and his entire staff will make this journey safe, comfortable and fulfilling for you.
Initial evaluation and screening is done very thoroughly prior to visiting the office. This involves Dr. Ezaldein’s personal and thorough review of your medical history, photographs, old records and any other pertinent information.
Once a thorough discussion has occurred and you are both satisfied, plans can be made to visit the office. This may be in one trip for consultation and surgery at the same time, or it may be split into two visits. You and Dr. Ezaldein will mutually decide on this.
Please call or contact the office for any further information or to schedule an appointment.
MIA- Miami International Airport (closest)
FLL- Fort Lauderdale International Airport (30 minute drive)
Numerous hotel options available in the Midtown, Downtown, Brickell and Miami Beach areas.
Dr. Ezaldein’s clinic is located very close to the Miami Design District, however several Airbnb/VRBO options exist for patients who do not mind a short drive or taxi to the clinic.
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