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 had terrible acne problems for the first time in 22 years and decided to try out this clinic. Right away the appointment was booked within the week and in my first consultation they offered me a long term plan and short term solution for the pain. The clinic is very clean and the staff is very friendly, they definitely make you feel at ease. On top of everything the doctors referred me to specific pharmacies that could offer me lower prices for the medications. My acne mostly cleared within a month but follow up visits made sure It cleared completely and made sure I was comfortable with the treatment and long term use."- D.C. / Google / Oct 26, 2019
"I have been to both offices and each experience was awesome. The staff and doctors are friendly and the service is the same as a five star restaurant or hotel.Dr. Dietert is very talented and is a wonderful person. She has a great concern for her patients and will do everything she can do to help.I highly recommend Snyder Dermatology and Dr. Dietert."- T.C. / Google / Oct 04, 2019
"I've been seeing Dr. Snyder for the past ten years. The first time was when I was splitting my time between Los Angeles and Austin while in graduate school. I had a major eczema problem on my skin. I had no clue that the skin problem was from the fumes of an art project I had been creating for a client, till I discussed the specifics of my days before the out break with Dr. Snyder. She was like one of those damn ghost whisperers, walking me through my days. When she nailed the source, she simply explained to me the problem was from the fumes of the chemicals I was working with at the time (industrial resin and a catalyst). She prescribed a steroid and gave me a skin routine, my eczema went away within a week. Amazing! She is still my "go to" dermatologist for other issues I have had over the past few years. Yes, I travel from LA to Austin to see her. She's that good. Keep in mind that she is straightforward and to the point but awesome!"- J.S. / Yelp / Oct 02, 2019
"Dr. PARKER is an incredible dermatologist. I called on Tuesday morning in a panic because of an allergic reaction - she fit me in later that day. Not only did she work quickly to diagnose the problem, but she prescribed medications that fit my difficult and specific allergies. I called on Wednesday to check in and she spoke on the phone with me personally, and is meeting with me for a follow-up as well. 10/10 doctor all around- truly cares about her patients. Would recommend her to everyone reading this!!!! Best dermatologist experience I've had- and I've seen a lot of them."- C.C. / Yelp / Aug 22, 2019
"Highly recommend seeing Dr. Dietert, fantastic doctor and a kind person. With her you know you are in great hands."- C.D. / Google / Jun 13, 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.