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Mohs Surgery

Mohs Skin Cancer Surgery and Skin Cancer Reconstruction FAQ

What is Mohs Skin Cancer Surgery?
Often times what you see with a mole or skin cancer is just "the tip of the iceberg". Cancer cells may have spread deeper under the skin and away from the superficial mole or bump on your skin. Mohs surgery, also called Mohs micrographic surgery, is a precise surgical technique that is used to remove all parts of cancerous skin tumors, while preserving as much healthy tissue as possible.

How is Mohs surgery done?
Mohs skin cancer surgery allows for the tissue to be examined through a microscope at the same time as the operation to ensure that all of the cancer cells have been removed adequately. The surgical removal proceeds along a grid pattern with each layer carefully identified and mapped by the surgeon so that its exact location can be pinpointed on the wound. If any cancer cells are seen under the microscope, the surgeon can go back to that exact area and remove more tissue. In our office, the defect (hole created from removing the cancer) will be closed and/or reconstructed by Dr Hoenig right away.

How is this different than regular skin cancer surgery?
The principle behind Mohs surgery is to remove all cancerous cells while minimizing removal of healthy tissue. Without Mohs, your doctor will remove the area of suspected cancer, send it to a lab, and wait a few days to find out if he got it all out. Meanwhile, you may be walking around with a bandage over the hole. If the pathologist says that all the cancer is removed, then your doctor will call you back (or send you to a plastic surgeon) to have the hole closed. If the pathologist says that there is still cancer visible in the specimen they received, then you will return to your doctor's office, have more skin removed, and repeat the process.

Is it really better to have Mohs surgery?
Having Mohs skin cancer surgery allows your doctor to make sure all the cancer cells are removed, minimize removal of healthy tissue, and close the skin immediately. Minimizing tissue removal is especially important for eyelids, lips, the nose, ears, and other facial areas where loss of even a few millimiters of skin can make a big difference.

Does having Mohs surgery guarantee that the cancer won't come back?
Using the Mohs microscopic surgery technique all visible cancer cells are removed. Even so, it is still possible to get a recurrence of the cancer in the same area but the chances are greatly reduced. With Mohs skin cancer surgery, there is a 95% cure rate, compared to 70-80% for the conventional treatments.

Isn't skin cancer surgery done by a dermatologist?
Not necessarily. Dr Hoenig is not a dermatologist but there is a lot of crossover between plastic surgery and dermatology. Often times a plastic surgeon is called in to perform the reconstruction on facial skin cancer surgery removals to make sure it looks as good as possible. As an eyelid and facial plastic surgeon, Dr Hoenig's background is ideal for this kind of sub-specialization.

Are there some types of cancer removal that cannot be done with Mohs surgery?
Yes. Melanoma, Merkel cell carcinoma, and sebaceous cell cancers usually are removed with Mohs surgery due to the highly aggressive and potentially lethal nature of these cancers. These lesions are removed by taking a large area around the mole and sending it to a special lab for examination. The hole created by doing so is closed immediately.

How long has Dr Hoenig been doing skin cancer reconstruction surgery?
Dr Hoenig started peforming skin cancer reconstruction surgery in 1999 and has performed over 12,000 skin cancer cases to date.

Will I have a scar?
Any time you cut the skin, you will have a scar. In most cases, the scar is barely perceptible. You can view photos of Dr Hoenig's skin cancer reconstructions (see below) to view the results of skin cancer reconstruction surgery.

Can I see before and after photos of skin cancer reconstruction?
To view before and after skin cancer reconstruction photos by Dr Hoenig, click here.

Dr Hoenig performs Mohs skin cancer surgery in conjunction with Dr. Robert Miller in Long Beach, California. Dr Miller is an experienced dermatologist and Mohs surgeon, who has been working with Dr Hoenig for the past 9 years. If you are interested in learning more about Mohs skin cancer surgery and facial reconstructive surgery, please feel free to contact us for more information or call the Long Beach office at 562.420.8333.

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