Mohs micrographic surgery, named after dermatologist Frederick E. Mohs, is a surgical technique used to treat skin cancers in sensitive areas, such as the face and nose. In this procedure, very thin layers of skin and subcutaneous tissue are carefully excised, processed, and examined with a microscope. By removing layers in an incremental manner, your doctor can be sure that all the cancer is cleared, and simultaneously normal tissue is spared. Mohs surgery offers both the lowest recurrence rate for malignant lesions and the maximum potential for preservation of healthy tissue. Mohs surgery is performed by specialized dermatologic surgeons who limit their practice to treating skin cancer patients.
Following cancer removal, the Mohs surgeon will frequently refer patients for reconstruction of the resulting defect. As a facial plastic and reconstructive surgeon, Dr. Ransom has extensive experience in this work. This teamwork approach helps to ensure the best possible outcome, both in terms of cancer care and cosmetic appearance – especially in highly visible and functional areas, such as the nose. Dr. Ransom uses complex local and regional flap repair techniques to ensure that your nose looks great and your breathing is unaffected.
Mohs surgery is more time consuming than traditional wide local excision. However, its precision is especially valuable for recurrent or aggressive carcinomas, for treatment of cosmetically important areas such as the nose, eyelids, lips, or chin, and for high risk and invasive lesions (such as those at the nostril, or near nerve branches in the face). Mohs surgery is commonly used to remove basal cell carcinomas (BCC), squamous cell carcinomas (SCC), some melanomas, and selected other precancerous or rare skin lesions.
After a malignant lesion is removed with Mohs surgery, a defect or hole in the skin remains. Such scars may be rather disfiguring, but reconstructive surgery may be performed immediately after Mohs surgery to repair the damaged site. Dr. Ransom specializes in carefully reconstructing the facial tissues in such patients, restoring the natural appearance of the facial contours and the delicate skin of the head and neck, and preserving the crucial functions of the facial structures such as the nose. Some defects require multiple stages, and Dr. Ransom has extensive training in complex and multi-stage Mohs reconstruction. Mohs reconstruction of the nose can be performed with local anesthetic only in nearly all cases, making the process easier for the patient and helping to promote a faster recovery.
Am I a candidate?
Patients with a skin cancer of the basal cell (BCC) or squamous cell (SCC) type in a sensitive location such as the nose are candidates for Mohs surgery. Mohs reconstruction (repair of a defect resulting from Mohs surgery) may be performed by your dermatologic surgeon in some cases. However, referral to a facial plastic surgeon such as Dr. Ransom is often made when the defect is large, lies in a complex 3-dimensional area, or requires multiple stages with flaps and tissue grafts. Dr. Ransom receives Mohs reconstruction referrals from multiple dermatologists in San Francisco and Marin County.
Frequently Asked Questions
Q: I would like Dr. Ransom to perform the reconstruction after my Mohs procedure. How can I schedule this?
A: First, you can discuss your preference for plastic surgery closure with your Mohs surgeon. Next, please call our office to coordinate the timing of the cancer removal and the repair. Lastly, either you or your dermatologist’s office can fax us the information about your skin cancer history and insurance plan. We will then work with you and your referring physician to create a plan that works for you!
Q: What type of anesthesia is used for Mohs surgery repairs?
A: In the great majority of cases, local anesthesia alone is used and the procedure is performed in our office. For very large defects, or at the request of the patient, sedation may be used in addition to local anesthesia. This can be arranged at our surgery center in the 450 Sutter building or at a hospital in San Francisco or Marin County.
Q: Does insurance cover the cost of Mohs reconstruction?
A: Yes, all major insurance providers, including Medicare, cover the costs associated with Mohs reconstruction. Depending on the specifics of your plan, you may have out of pocket costs associated with your deductible, co-pays, and patient responsibility, etc. For these procedures, Dr. Ransom accepts all major PPO plans and is contracted with Medicare. If you have a question specific to your coverage, please feel free to contact our office.