Dr. Ostad answers your questions

Why is it called Mohs surgery? Is Mohs an acronym?

The term “Mohs” refers to Dr. Frederic Mohs, Professor of Surgery at the University of Wisconsin, who developed this surgical technique in the 1930s. The technique has undergone many refinements and has come to be known as “Mohs micrographic surgery” or simply “Mohs surgery” in honor of Dr. Mohs.

What is Mohs surgery?

Dr. Mohs recognized that a skin cancer often resembles the “tip of the iceberg” with more tumor cells growing downward and outward into the skin like the roots of a tree. These “roots” are not visible with the naked eye, but can be seen under a microscope.

Mohs surgery is a highly specialized and precise treatment for skin cancer in which the cancer is removed in stages, one tissue layer at a time. It is an outpatient procedure, performed under local anesthesia, and is distinguished by a specific technique of tissue examination that is unique to

Mohs surgery. Although other surgical specialists may check excision margins, this form of pathologic examination of the tissue is not the same as Mohs surgery.

Mohs surgery is the only method that allows for 100% examination of tissue edges and the base, unlike conventional removal that only examines a few random pieces of tissue at the pathologist’s discretion. Simply excising (removing) the cancerous tissue without checking 100% of the margins, first, is just not as precise.

Once a tissue layer is removed, its edges are marked with colored dyes, and a map of the specimen is created. The tissue is then processed onto microscope slides by a Mohs histotechnician. These slides are carefully examined under the microscope by the Mohs surgeon so that any microscopic roots of the cancer can be precisely identified and mapped. If cancer cells are seen, an additional tissue layer is removed only in areas where the cancer is still present, leaving normal healthy skin intact and minimizing the size of the wound and therefore a better cosmetic This saves as much normal, healthy skin as possible.

Once the cancer has been removed, Dr. Ostad will explain options for repair of the wound, including but not limited to: natural healing (granulation), stitching the wound together using a side-to-side closure, or using a skin flap or graft.

What is the difference between Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC)?

Basal cells arise from the lowest portion of the epidermis and typically have roots. These relatively slow growing tumors typically do not travel throughout the body but have the ability to destroy nerves and adjacent structures. If left alone, they can cause deformity to the area and also compromise function.

Squamous Cells arise from the middle portion of the dermis. Unlike basal cells, this type of skin cancer is fast-growing and can travel through the body to lymph nodes and other organs. While most non-melanoma skin cancers are due to sun exposure, squamous cell carcinoma can also occur due to a virus called Human Papilloma Virus (HPV) .

I don’t see anything after my biopsy. Do I really need to be treated?

Yes. Following a biopsy, your skin cancer may no longer be visible. However, the surface lesion that was removed can represent the “tip of the iceberg.” More tumor cells may remain in the skin. These can continue to grow downward and outward, like roots of a tree. These “roots” are not visible with the naked eye. If they are not removed, the tumor will likely reappear and require more extensive surgery. Tumors that are neglected can spread deeply into the skin and invade nearby structures. On rare occasions, these cancerous cells can metastasize to lymph nodes and other organs in the body.

Dr. Ostad is one of the top Mohs Micrographic/Cosmetic surgeons in New York and beyond due to his expert closures. His cosmetic surgery training and experience are essential to giving the patient a brilliant aesthetic outcome. A member of the American Academy of Dermatology and the American Academy of Cosmetic Surgery (AACS), patients marvel at Dr. Ostad’s ability to not only treat them medically, but provide outstanding cosmetic results as well.