Mohs Micrographic Surgery

Mohs Micrographic Surgery is the gold standard for treating skin cancer. Named after Dr. Frederic Mohs, it is a tissue-sparing technique for skin cancer removal where healthy tissue is left untouched, while cancerous tissue is removed until clear.

It is typically performed as an outpatient procedure using local numbing for anesthesia, meaning you are awake the entire procedure, but will not feel pain. Mohs Micrographic Surgery is a precise surgery where the skin cancer is removed in stages, the removed tissue is mapped and evaluated under the microscope in an in-office laboratory while the patient waits in the exam room.

These stages are repeated until it is confirmed there are no cancer cells remaining and the tumor is completely removed. Depending on the depth of the tumor, board-certified Mohs surgeon Dr. Michael Sotiriou may need to remove the tumor in one or more stages. Each stage can take up to an hour to remove, process, and evaluate. While the initial appearance of a skin cancer may be a small mark, it may be only the tip of the iceberg with deep roots into the skin as it is tracked and excised. Patients should be prepared for surgery that might take multiple stages and multiple hours.

After the cancer is cleared, Dr. Sotiriou will discuss with you the best way to repair the wound that remains. There are many options including suturing the wound closed in a line, performing a flap or graft, or letting the wound heal from the edges. He has received extensive training to help you achieve the best cosmetic result after clearing your cancer. In rare cases, after the cancer is cleared, you may be referred to a fellow physician for reconstruction.

Mohs Micrographic Surgery offers superior cure rates and preservation of healthy normal tissue while getting to and removing the roots of skin cancer.

What are the advantages of Mohs Micrographic Surgery?

Mohs surgery is beneficial because:

• It allows the surgeon to see when there is no more cancer.
• It requires a single outpatient visit.
• Surgery is performed under local anesthetic.
• Slide specimens are processed in a CLIA-certified Mohs lab in our office.
• Mohs Micrographic Surgery is a safe procedure with low rates of infection.
• Mohs Micrographic Surgery minimizes the amount of healthy tissue that must be removed. This is particularly important in areas where open surgery could cause disfigurement or affect function.
• The wound can be closed with stitches or surgical reconstruction with a skin graft the same day
• It leaves the smallest possible scar, minimizing disfiguring scars and provides a better cosmetic result.
• Offers the highest cure rate 99% for previously untreated skin cancer and 94% for recurrent skin cancer

What types of skin cancer can be treated with Mohs Micrographic Surgery?

Mohs surgery is the treatment of choice for skin cancers of the face, eyelids, eyebrows, cheeks, forehead, scalp, nose, lips, jaw, ears, temples, neck, hands, genitals, and any area of the body where open surgery could cause disfigurement and affect function. It is safe and standard of care for basal cell and squamous cell cancers.

Mohs Surgeon Dr. Michael Sotiriou

Mohs surgery is a highly specialized form of skin cancer treatment where the surgeon acts as both surgeon, pathologist, and cosmetic/reconstructive surgeon. Dr. Michael Sotiriou is a board-certified Mohs surgeon, having passed the first ever administration of the American Board of Dermatology’s Micrographic Dermatologic Surgery sub-specialty exam.

While living and working in Chicago prior to moving to Salt Lake City, Dr. Sotiriou spent a year working with two widely respected Mohs surgeons, learning their craft, and honing his skills in micrographic surgery, reading Mohs surgery pathology slides, and learning reconstruction techniques. In addition to his board certification in Mohs surgery, he is a member of the American Society for Dermatologic Surgery and American Society for Mohs Surgery.

How does Mohs surgery compare with conventional skin cancer surgery?

Conventional skin cancer surgery is called wide local excision, or elliptical excision. This technique removes the tumor and margins, a repair is performed, and the specimen is sent to a laboratory for evaluation. Results are returned in days and only 2-5% of the specimen is examined to confirm clear margins. In Mohs Micrographic Surgery, 100% of the margin is examined to ensure complete removal of the cancer. By examining 100% of the tissue margin, Mohs surgery scars often result in small wounds, which leads to smaller scars

How do cure rates compare?

Mohs Cure rates exceed those achievable with wide local excision.

Basal Cell Carcinoma (BCC) is the most common skin malignancy. While it rarely causes major complications, it can be locally destructive invading deeper tissues like muscle, cartilage, and bone. Mohs Micrographic Surgery has been shown to have superior cure rates for primary and recurrent BCCs. It is also efficient and cost-effective and is the treatment of choice for BCCs in cosmetically sensitive locations.

Squamous Cell Carcinoma is the second most common form of skin cancer. However, unlike BCC, SCC caries a risk for metastases to other parts of the body. The best chance for a cure is complete surgical removal of an SCC. Treatment with Mohs Micrographic Surgery has shown superior cure rates and lower risk of local recurrence than with wide local excision.

Other rare tumors that can be treated with Mohs Micrographic Surgery include sweat gland carcinomas, sebaceous carcinomas, Dermatofibrosarcoma Protuberans, desmoplastic trichoepithelioma, and other skin cancers.

When you or a loved one is concerned about an unusual mark on the skin it is essential to have it evaluated by a board-certified dermatologist. While it can be scary being diagnosed with a skin cancer, you know you are in great hands with Dr. Michael Sotiriou, a board-certified dermatologist and board-certified Mohs surgeon, to help diagnose and treat your skin cancer. Contact Dr. Sotiriou at Salt Lake Dermatology & Aesthetics.