Mohs surgery

Mohs, also known as Mohs micrographic surgery, is a specialized surgical technique to remove skin cancer utilizing a surgeon and a Dermatopathologist. Mohs has become the treatment of choice for basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) with recurrence rates as low as 1%. Mohs may also be used to remove the malignant melanoma. Mohs technique examines 100% of the tumor margins while other surgical excision techniques examine as little as 2%. The Mohs technique was first developed by Dr. Frederic E Mohs in the 1930’s and has been refined and perfected over the last 55 years. Mohs’ excision technique creates a map to identify the location of remaining cancer cells so the surgeon can remove them while sparing healthy skin.

Following the removal of your skin cancer, your surgeon may repair the defect created by the Mohs procedure. This occurs on the same day or a few days after. An increased risk of skin cancer developing in a similar area exists, therefore your surgeon may recommend additional treatments for risk reduction. Please schedule an appointment to discuss Mohs surgery or other options if you have a skin cancer.

Slow Mohs Surgery

“Slow Mohs” is a specialized procedure for the removal of melanoma and nonmelanoma skin cancers. Slow Mohs is a modified form of Mohs Micrographic Surgery. Like conventional Mohs, it is a staged, margin-controlled excision. Slow Mohs surgery provides patients with the highest cure rate, while preserving as much normal tissue as possible. By preserving all the normal tissue possible, a smaller defect (wound) is created, resulting in a smaller scar. Reported recurrence after Slow Mohs is less than 1%. Additional laser, BLU light and chemical peel treatments after the surgery will further decrease recurrence of skin cancer and improve cosmetic appearance.

Although it is called ‘Slow’ Mohs, the tissue is actually given high priority by Hawaii Pathology Laboratories (HPL) and Dermatopathologist Dr. Chris Lum to provide pathology results within 12-24 hours following surgery. Slow Mohs is treated in one to two days, although 98% of procedures only require a one day, 60-90 minute surgery to remove and repair.

Surgery Day 

Wash the area with a liquid soap before coming to the clinic. If the procedure is on your face, do not wear any make-up. Wear comfortable, layered clothing.

You may eat regular meals on the day of surgery, including breakfast. An MP3 player may be used during the surgery. Take all routinely prescribed medicines, including any prescribed for blood thinning unless PA Williams or Dr. Pasquale advises stopping for a time. Do, however, stop all unnecessary blood thinners including over the counter supplements. If you have had a heart valve replacement, joint replacement, or organ transplant, please make your surgeon aware of your need for prophylactic antibiotics prior to your surgery. Most of these patients will have already taken prophylactic antibiotics prior to dental procedures in the past.

Procedure & Pain

Patients can have Slow Mohs procedure performed with little to no pain. Slow Mohs is performed under local anesthesia but additional medication that relaxes you (anti-anxiety) and relieves pain can be provided prior to surgery, although a driver will be required. In most cases, patients are very comfortable taking over the counter extra strength Tylenol and Benadryl. Following anesthesia, tumor edges are defined with an additional safety margin, inked for orientation and removed. A surgical repair is needed following removal. A simple linear repair with stitches can be performed in most cases, while others may require plastic surgery. You will have bandaging after repair and will be given specialized written instructions on how to care for the surgery site. One or more appropriate follow-up visits, including suture removal, will be scheduled and appropriate post-operative pain medications will be provided.