Dr. Shirazi is certified by the American Society of Mohs Surgery and has extensive experience in performing Mohs procedure. As a highly acclaimed cosmetic surgeon, she has the experience, knowledge, and training to ensure the highest cure rate and best cosmetic outcome during this tissue sparing procedure.
Mohs Surgery
Mohs micrographic surgery is the most advanced and effective technique in the treatment of skin cancers. It is a minimally-invasive procedure that uses a precise surgical technique to remove and cure skin cancers while minimizing the degree of scarring. Mohs surgery allows the surgeon to verify that all cancer cells are removed at the same time as the surgery, therefore reducing the need for additional treatments.
The procedure
The Mohs surgery procedure is an outpatient surgery performed in our accredited operating room under local anesthesia. Our surgical suite is equipped with an onsite laboratory to perform microscopic examination of the tissue and cancer cells that are removed. Typically, the procedure begins early in the morning and is completed on the same day. The surgeon begins by first meticulously marking the area of the skin that contains the cancer cells. The area is then cleansed, numbed, and draped to ensure that you don’t experience any pain. The smallest incision is made to ensure as little tissue as necessary is removed to clear the tumor with the first layer. The tissue is then mapped and marked for orientation. The specimen is then given to a Mohs technician to process and place on slides for your surgeon to examine under the microscope.
If the surgeon sees evidence of cancer in the edges of this first layer, then she takes another layer only from the area that still contains the cancer cells. This ensures that only the cancerous cells are removed and normal healthy skin is spared. The surgeon then repeats these steps until all the cancer cells are completely removed and your healthy tissue is spared. Typically, skin cancers take anywhere from 1-3 layers for complete removal, although there are exceptions.
Following complete cancer removal, the defect is reconstructed in the utmost cosmetic fashion. As a highly acclaimed cosmetic surgeon, Dr. Shirazi will typically hide scars in natural skin lines and folds to ensure the best cosmetic outcome with very little scarring. There are times when a skin graft or skin flap is required based on certain locations and in certain cases.
What should I expect from this procedure?
Your skin cancer will be removed by the surgeon with a small margin and the Mohs surgical tech will process the tissue for pathologic evaluation. The tech will prepare pathology slides for the surgeon while you wait in our Spa suite where we provide drinks, snacks, and warm blankets to make you feel comfortable. The Mohs surgeon, Dr. Shirazi, will then evaluate all of the margins. If the margins are cleared, your wound will be reconstructed with cosmetic surgery for the best outcome.
However, if the margins are positive for tumor, more tissue will be removed only from the area of skin that still has tumor. This is tissue sparing, ensuring as little removal of skin as possible to clear the skin of tumor. It’s recommended you come with someone who can drive you home from the surgery if possible. The reasons are:
- You may have post-surgical discomfort from swelling
- If you are on medications that may impair your ability to drive.
- If surgical procedures are close to the eye area, there may be temporary obstruction of your vision.
The Day of Surgery
- Take a full-body shower, cleanse with soap on the morning of surgery. Wear freshly cleaned clothing and avoid makeup or lotions.
- It’s best to wear button-up or zip-up shirt or blouse if your surgical site is above your waist.
- Have a big, healthy breakfast.
- If you wear contacts, it’s best to wear glasses unless you plan on driving yourself and the site is close to the eye area.
- Do not wear jewelry in areas of your body that are near the surgical site.
- If you require pre-operative antibiotics, take them 1 hour prior to your scheduled surgical time.
- Follow any additional instructions your surgeon may provide during your consultation.
Post-surgical care
After the surgery, a pressure dressing is placed on the wound. You will be instructed to keep the area dry for 24-48 hours. Post-surgical minor bleeding, bruising, pain, and tenderness are common the first 24-48 hours. You are advised to avoid strenuous activities and rest during the healing period.
Certain medications may be prescribed following your procedure and additional follow-up is made to ensure optimal healing of your skin. Follow the instructions provided with care for a quick recovery. At the La Jolla Dermatology and Laser Surgery Center, we have extensive experience in Mohs surgery. Feel free to contact us for more information or to seek treatment at our La Jolla skin care clinic.
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