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Too Much or Too Little?

Published on June 28, 2019

Mohs surgery is considered the gold standard for the treatment of most skin cancers. However, not all Mohs surgeons perform the procedure the same way.

When performing Mohs micrographic surgery for the treatment of skin cancer, the surgeon starts by removing what he/she estimates to be “just enough” tissue to clear the cancer. Obviously, you do not want your surgeon to take too much and create a larger hole than was needed. But at the same time, if he/she takes too little, extra stages will be needed until the cancer is cleared.

Some cancers have subclinical extensions (like the roots of a weed) that go well beyond what is obvious on the surface. In these cases, a Mohs surgeon will need to perform multiple stages to get clear margins. In other cases, the cancer is more limited and a single stage is all that is needed.

So, on average, how many stages of Mohs should a Mohs surgeon be performing overall? A recent study published in JAMA Dermatology indicated that the average rate should be between 1.4 and 2.4 stages.

Many cases only require a single stage, while others need multiple stages. The ability to take the appropriate amount of tissue with each stage is not an exact science. It is something that comes through training, experience, and judgement.

Dr. Ralph Massey is a world-class cosmetic and skin-cancer surgeon. He completed his fellowship in Mohs micrographic and cosmetic surgery at Columbia University and served as an assistant clinical professor at both Columbia University and UCLA.

In addition, he has enjoyed years of experience and is now recognized by many as the “go to” surgeon for skin-cancer management. Contact our office today and set up a consultation to find out more about Mohs surgery and what it can do for you.

Citation:
Outlier Practice Patterns in Mohs Micrographic Surgery Defining the Problem and a Proposed Solution
Aravind Krishnan, BA1; Tim Xu, MPP1; Susan Hutfless, PhD2,3; et al and the American College of Mohs Surgery Improving Wisely Study Group
JAMA Dermatol. 2017;153(6):565-570.

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