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Mohs Most Frequently Asked Questions
(Click on desired question; most answers will appear near top of page; then click up-arrow to return)
What is skin cancer? Is skin cancer dangerous?
What causes skin cancer? What is Mohs surgery?
Is there a board certification for Mohs surgeons? What is the difference between Mohs and Standard Surgery?
What are the advantages
of Mohs surgery?
What are my chances for cure using Mohs surgery?
What is skin cancer?
Skin cancer is the most common malignant tumor in human beings. Cancers are tissues which grow at an uncontrollable and unpredictable rate.  The word "cancer" elicits a great deal of fear and anxiety; but all forms of cancer are different. The most common forms of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.  By far, basal cell carcinoma is  the most common type of skin cancer
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Is skin cancer dangerous?

Basal cell carcinoma rarely breaks off and spreads (metastasizes) to internal organs or distant parts of the body; it is very rarely fatal.  However, if left untreated this skin cancer can invade quite deeply and involve underlying structures including nerves, bones, muscles, tendons, and occasionally can penetrate into the eye, skull or brain.

Squamous cell carcinoma is the second most common type of skin cancer. Like basal cell carcinoma, this cancer frequently invades and destroys adjacent structures if incompletely removed. Squamous cell carcinoma does have the capacity to metastasize, although this is uncommon.

Melanoma is the third most common type of skin cancer, and is increasing at an alarming rate. Although it may be life-threatening if not treated early, melanoma is easily cured with complete surgical removal in its early stages.   Melanoma typically appears as an unusual brownish-black spot on the skin which enlarges or changes.  It may also develop in an existing mole as evidenced by changes in shape, color, size, or by bleeding.
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What causes skin cancer?

Excessive exposure to sunlight is the single most important factor in the development of skin cancer. Although many victims of skin cancer were never "sun worshippers," the lifetime cumulative exposure to the sun through normal outdoor activities from childhood on through adulthood contribute to the development of skin cancer.

Additional causative factors for skin cancer include x-ray treatments for acne or prior cancers, and certain chemicals such as arsenic.  The tendency to develop skin cancer is often inherited along with your complexion.  For example, fair skinned persons have less inherent protection against the sun; thus, they are more likely to develop skin cancer with less sun exposure than dark skinned persons.
What causes skin cancer!

What is Mohs surgery?

Mohs micrographic surgery is the most modern, accurate, and most highly specialized treatment for the total removal of skin cancer.  Mohs surgery (pronounced like "nose" with an "m") is named in honor of Frederick Mohs, M.D.; the physician who developed the technique at the University of Wisconsin in 1936. Mohs method of skin cancer treatment is unique because it is the only method that provides the use of complete microscopic examination of all the tissues removed surgically, in addition to providing detailed graphic mapping techniques for orientation purposes; thus the term micrographic surgery.

This procedure allows the surgeon to visualize and remove every cancer cell.  It is initiated after the skin has been numbed with a local anesthetic. The visible portion of the cancer and a very thin rim of surrounding skin are then removed and examined.  Any remaining cancer seen during the microscopic examination is carefully marked on a map, which precisely locates the area relative to the patient's skin.  Another thin layer of tissue is then removed from the exact area that demonstrated involvement with cancer.  This sequence is repeated as often as necessary to completely remove the cancer.
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Is there a board certification for Mohs surgeons?

Although there is no specific board certification for Mohs surgeons, there is a single organization which oversees post-graduate fellowship training and regulates the requirements for comprehensive training in this specialty. The organization is known as The American College of Mohs Surgery (formerly the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO)).

Although there are other societies with similar names, only the ACMS requires extensive proctored fellowship training and proven competence under the supervision of a regulated director.  It is very important that patients understand that the high cure rates often cited for Mohs surgery are results of studies performed by ACMS members and may not represent results attainable by physicians who have not received ACMS fellowship training. Dr. Griego is a Fellow member of the ACMS.  
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What is the difference between Mohs and Standard Surgery?

Mohs surgery examines 100% of the margin of the excised tissues. This is accomplished by a special method of tissue orientation during processing.  Excision using typical "frozen sections" prepared in a hospital, and standard surgical excision in the office which uses paraffin embedded section examination merely sample the edge of the excised tissues. These alternative forms of tissue examination provide only a tiny sampling of the tumor margin.

Only Mohs surgery utilizes a single physician in two capacities:  (1) as the surgeon, and (2) as the pathologist.  By knowing exactly how the tissue was removed, oriented, divided, and mapped, the Mohs surgeon can most accurately analyze the excised tissues. 
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What are the advantages of Mohs surgery?

By using these detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed.  In addition, the complete examination of the tumor periphery removes the need for excision of a "margin for error," and allows for surgical margins 1/2 to 1/6 of that required for standard surgery. The results are: (1) The highest possibility for curing the cancer, and (2) The removal of as little normal skin as possible.  
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What are my chances for cure using Mohs surgery?
As result of the complete and detailed microscopic examination of all the skin surrounding the skin cancer, Mohs surgery performed by Dr. Griego offers a chance for cure greater than 99% for most skin cancers, even when other forms of treatment have failed.  Other methods of treatment may offer only a 50% chance of success when previous treatments have failed.
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