What is Mohs Surgery?
Snyder Dermatology, located in Austin and Round Rock, TX, offers Mohs Micrographic Surgery with our board-certified dermatologist and fellowship-trained Mohs surgeon, Dr. Nikki Dietert. This technique is used to treat basal cell and squamous cell cancers of the skin, as well as other less common types of skin cancer.
Mohs Micrographic Surgery is a technique developed by Dr. Frederic Mohs in the 1930s. This precise technique has a cure rate of up to 99 percent. The technique is unique in that the Mohs surgeon is also the pathologist, examining 100 percent of the tissue margins on the day of surgery. This can ensure a microscopic removal of the tumor and its roots with the highest precision. The skin cancer is removed, treated with a special dye, and processed by freezing and cutting to place the tissue on microscope slides. The surgeon then examines the microscope slides to determine if more tissue needs to be removed to clear the skin cancer. The process is repeated until the tumor is clear.
This specialized technique allows for the removal of unhealthy tissue, decreasing the overall tissue margins, and sparing as much healthy skin as possible. Minimized scarring is ideal for visible, cosmetically-sensitive areas. By performing the pathology on the same day, this also eliminates waiting days for the results.
As this is an intricate and detailed surgery, it is imperative to be treated by an experienced board-certified dermatologist with specialized Mohs training. Dr. Dietert completed a Mohs surgery fellowship following her dermatology residency. During a fellowship, all Mohs surgeons are also trained in wound reconstruction techniques once the skin cancer has been removed. In addition, our practice includes an on-site plastic surgery center should a consultation be needed.
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The day of surgery, the area will be numbed using a local anesthetic. The visible portion of skin cancer is then surgically removed with a small margin. This removal is done in a specific fashion to ensure the entire under-surface and skin edges will be examined microscopically. The tissue is then processed in the lab to prepare microscope slides. The surgeon then reviews the tissue under the microscope to identify if and where residual tumor remains. This is drawn onto a map that coordinates with tumor location on the patient. Subsequently, the process is repeated until there are no more cancer cells present.
Once the skin cancer is removed, repair options will then discussed to determine how to best manage your wound. Certain areas may be allowed to heal on their own. Smaller wounds can usually be closed side-to-side with sutures. Larger wounds may require a skin graft or flap. Under certain circumstances, a plastic or an oculoplastic surgeon will help assist in the closure. If required, this is usually planned for ahead of time to coordinate with the Plastic surgeon.
"I've been a patient at Snyder Dermatology for about a year and a half. The second you walk into the Louis Henna location, you are greeted with a warm welcome. I really love that I can call the office and be seen by Dr. Cervantes within a week and a half or less. The staff is respectful of your time, and you can expect to spend little to no time in the waiting room before being called back. Dr. Cervantes is absolutely amazing, and really takes the time to diagnose you properly. She is friendly, professional, and extremely competent. I had a bad rash on my skin that I had confused for acne. She was able to properly diagnose me and my skin is back to being as smooth as a baby's bottom!There is also a wide array of cosmetic services offered at the office at competitive prices. They also offer samples of cleansers, creams, etc. which is really a great bonus."- C.P. / Google / Feb 28, 2019
"What is wrong with me that I love coming to the dermatologist? Maybe because Dr. Foley and Pam are just the best - so professional, caring, kind, and do just what I need done with no pushy extra stuff. It's like coming to see friends who know how to keep me healthy and looking better than when I entered. I love them! More Botox coming up..."- M.R. / Yelp / Feb 08, 2020
"Dr. Parker is absolutely incredible. I have seen her for an in-office cyst removal at just the cost of my co-pay. She was gentle and kind and the surgery went incredibly well. I have had cysts removed from other physicians in the past, but Dr. Parker surpassed my expectations. I have also seen her for eczema and skin irritation issues and she always sends me away with soothing words and soothing creams. I highly recommend her for any dermatological needs."- R.N. / Yelp / Feb 06, 2020
"Dr. Arranda is amazing! Very professional. Really listens to you and answers all your questions. Cares about her patients and always treats you with respect. Helps you with whatever problem you came in with ."- V.B. / Google / Jan 18, 2020
"The Austin Medical Community is honored to have a Dermatologist with the expertise and care that Doctor Jennifer Aranda, MD, provides. Bill McCarron, MD Dec. 2019."- C.S. / Google / Dec 11, 2019
What to Expect
Mohs surgery is performed on-site at our office in Round Rock, TX. As the process is detailed, there is some waiting time on the day of surgery in between skin cancer removal while the tissue is processed for microscopic examination. The length of wait time depends on the number of layers required to completely remove cancer. On average, one to three rounds of removal are typically required, with each round taking approximately one hour of wait time.
The wound will then be repaired with sutures or may be allowed to heal without sutures. If a Plastic surgeon is consulted, they will repair the wound after the Mohs process is complete.
Dr. Dietert will see you in consultation prior to scheduling surgery. It is essential to
bring a list of all medications that you are currently taking. In addition, the surgeon should be informed of
- Current use of any blood thinner/anticoagulant
- Prior history of heart disease or stroke
- If you have a pacemaker or implanted defibrillator
- History of joint replacement
- If you require antibiotics before a dental procedure
- Any allergies to medications or medical equipment such as latex
- Smoking status
- Previous Mohs surgeries and skin cancers
After Mohs surgery, we will provide detailed aftercare instructions and ways to manage discomfort. Activity limitations will be discussed with Dr. Dietert. While the majority of patients are able to return to normal activities by the next day, patients must refrain from taking part in strenuous exercise for 1 – 3 weeks. Wounds that required sutures will need a suture removal visit ranging from 6– 14 days following surgery. Additional follow-up may be required and will be scheduled as necessary.
Schedule Your Consult
For any skin cancer patient considering Mohs micrographic surgery as a treatment option, it is extremely important to find the right dermatologist and surgeon. The success rate of this skin cancer treatment is highly connected to the experience and care of the surgeon performing it. At Snyder Dermatology, our team of doctors work together to diagnose, treat, and manage skin cancer, and will work closely with the patient to map out the best course of treatment. Call our Round Rock, TX dermatology office today to schedule a consultation.