About Mohs Surgery
Dr. Tracy Evans is fellowship trained to perform Mohs surgery and has over ten years of experience with the procedure. Mohs micrographic surgery is currently the most effective and precise procedure for removing multiple types of skin cancer, including melanomas, squamous and basal cell carcinomas, and other lesser-known types. For men and women diagnosed with skin cancer, Mohs surgery is often the best course of action. The goal of the procedure is to remove all of the cancerous cells while leaving as much of your healthy tissue intact as possible. To perform Mohs surgery, Dr. Evans removes the cancerous tissue one cellular layer at a time and examines each layer under a microscope to check for the presence of cancer cells. If Mohs surgery has been recommended for you or a loved one, schedule a consultation with Dr. Evans at Pacific Skin and Cosmetic Dermatology San Francisco & Marin. It is important to find a fully trained and experienced surgeon for this procedure.
Mohs Surgery Reviews
"I have been seeing Doctor Evans and her excellent PA, Lauren, for over 2 years. I switched dermatologists in late 2016 as a previous PA failed to diagnose skin cancer on my nose. Another doctor, my GP, noticed the spot and recommended that I immediately get a second opinion. I was lucky enough to get in to see Lauren straight away who moved quickly to biopsy the troublesome area. Unlike the other PA, Lauren was concerned about my symptoms, the length of time I was dealing with them and appearance of the spot. Her depth of knowledge and confident, yet caring demeanor helped put me at ease. Unfortunately, the spot turned out to be aggressive basal cell carcinoma. I was diagnosed in mid Dec and Dr. Evans moved mountains to help book me for Mohs surgery before the Holidays. She also went above and beyond to line up an excellent plastic surgeon in the event my surgery was challenging to close. I am forever grateful as my surgery was quite extensive. At the age of 38, I had 5 rounds of scrapping in a single Mohs surgery which left me with a hole the size of a quarter on my nose. Dr. Evans performed the surgery with skill and ease in her office ensuring I was comfortable throughout the 5-hour operation. I feel incredibly lucky to have seen Lauren and Dr. Evans. It was an emotionally draining process with an unforeseen outcome, but I was given unbelievable care and support from Dr. Evans and her entire staff. Once I healed, they've since helped with regular skin checks and laser treatments to help reduce the appearance of the scar. It has healed beautifully! I've recommended many friends to their practice. While I know at times you can wait for an appointment to begin, to me, it's worth it to ensure I am given superb care."- K.D. / Yelp / Jun 11, 2018
"Dr. Evans takes great care to attend to her patients. She is extremely professional and able in her dermatology practice, attentively interacts with her patients, gives them her full attention, is current and experienced in providing a variety of procedures, and has a kind and caring staff to assist her. Both of us have had a MOHS procedure performed by Dr. Evans and the results have been excellent - hardly any scaring despite the severity. We highly recommend Dr. Evans as one's dermatologist. Marston & Sandra Nauman Sandra & Marston Nauman"- S.N. / Google / Aug 29, 2019
"Dr. Evans takes great care to attend to her patients. She is extremely professional and able in her dermatology practice, attentively interacts with her patients, gives them her full attention, is current and experienced in providing a variety of procedures, and has a kind and caring staff to assist her. Both of us have had a MOHS procedure performed by Dr. Evans and the results have been excellent - hardly any scaring despite the severity. We highly recommend Dr. Evans as one's dermatologist. Marston & Sandra Nauman Sandra & Marston Nauman"- S.N. / Google / Oct 03, 2019
"Dr. Evans has performed Mohs surgery on my face twice and I could not be happier with the results. For the past couple decades, I have spent almost every Summer in the South of France because I have family and friends there. Of course it is a sunny place with lots of gorgeous beaches and other outdoor activities. I guess I got a little too much sun exposure on these trips, especially since I have fair skin and blue eyes. When I first found out I had a basal cell spot on my face I was very upset, but Dr Evans and her staff are absolutely amazing!!! I had never had any surgery on my face and I was worried about it, but I truly felt I had the kind of empathy and care that you would get from a family member or a great friend, from Dr. Evans and everyone else on her team. Dr. Evans did such a great job on both surgeries and they have healed so well, so much so that no one even notices that I have had two surgeries on my face. I have been going to her office for years now with regular skin checks and I have to say I am extremely impressed with the entire staff. In addition to the Mohs surgery, and after I had basal cell a second time, I decided to get Fraxel Laser done at Dr. Evans office. A lot of people do this for cosmetic reasons, but I did it because I found out that Fraxel can help reduce the chance of getting basal cell in the future. As a guy, I did not see myself spending thousands of $’s on laser for my face the first time, but after I got the 2nd basal cell on my face I decided it was worth the money if it reduced the chance of more basal cell in the future. I was very pleased with the Fraxel procedures and I have not had another basal cell issue since I had it, so I am very happy with the decision. The Fraxel laser procedure also evened out the toning on my face, so that was great as well. I highly recommend the Fraxel Laser to anyone who wants to potentially reduce the chance of basal cell, and I also have been taking Nicotinamide (a special form of vitamin B) which can also potentially reduce future basal cell issues, and I use a DNA enzyme repair cream at night which reduces the chance of basal cell. As I said before, I have not had basal cell since I had the Fraxel and I think taking Nicotinamide and using the DNA enzyme repair cream all have helped. After all this I realize how important skin care is and I am grateful that I got such great care. Most of my friends never go to a dermatologist and have an ignorance is bliss attitude, but with Dr. Evans and her amazing team, I am much more aware of how important it is to get regular checks and what can be done to maintain my skin going forward. My skin looks great and people think I look much younger than my actual age. One final point: I also have a couple friends that have HMO insurance that also have had basal cell. They have had surgeries at their HMO and I can tell you the care and the results they received are not even close to the care and outstanding results I have had with Dr. Evans. In some cases, the HMO made my friends wait a long time before they could even get the Mohs surgery and they also made mistakes, and their results in terms of scarring and healing were not the best. There is no way I would trust an HMO to do this surgery. At this point, I would only trust Dr. Evans with something this important. Thanks to Dr. Evans, Clarence, Shantelle, Kirstie, Danielle, Leslie, and the entire team! You all have helped me in a difficult situation more than once and I got through it as if nothing ever happened because of your amazing care and skills!"- E.R. / Yelp / Sep 25, 2021
"The entire team that worked on removing my skin cancer was caring and showed genuine concern for me. The treatment rooms are modern and have all of the latest equipment. I highly recommend Dr. Evans for the Mohs Procedure I had done as well as all your dermatology needs."- G.C. / Google / Nov 30, 2019
The Mohs surgery technique is primarily used to treat the two most common forms of skin cancer, squamous cell carcinoma and basal cell carcinoma, as well as a variety of other skin cancer subtypes. If you are suffering from melanoma or another form of rare skin cancer, a consultation will help determine if you are a good candidate for Mohs surgery. In addition to the type of skin cancer you have, there are also other qualifying criteria that make you a good candidate for Mohs surgery.
Mohs surgery is the best option if your cancer has a high risk of returning or if it has already returned after being treated. It is also best for cancer located on the ears, mouth, nose, or around the eyes because the precision of Mohs surgery decreases scarring and damage to surrounding tissue. Skin cancer lesions or tumors that are large, aggressive, or have undefined borders are also best treated with Mohs surgery.
Before your procedure at Pacific Skin and Cosmetic Dermatology San Francisco & Marin, Dr. Evans will apply local anesthetics to numb the affected area. She will then use a scalpel to carefully remove all of the visible tumor or lesion, plus a tiny bit of surrounding tissue. After the removal, Dr. Evans will cut the cancerous tissue into sections and dye them to correspond to a diagram called a Mohs map. This color coordination ensures that Dr. Evans knows exactly how the excised tissue was situated in the skin.
Your removed tissue will then be frozen so that extremely thin layers can be sliced off of the edges and bottom and then examined with a microscope. Dr. Evans performs this microscopic examination as well because she is specially trained in reading the microscope slides to correlate the microscopic findings with your surgical site. Any cancerous cells she discovers during this examination are marked on the Mohs map, which will direct her in where to remove another layer of tissue. These examinations and layer removals continue until no more cancerous cells remain.
The length of your procedure and the number of layers that need to be removed will depend on the stage of your cancer. Mohs surgery does create a wound, but the severity of the wound will depend on the size and depth of your surgery. Healing solutions after Mohs range from simple sutures to close the wound to more complex reconstructive (plastic) surgery for larger wounds.
What to Expect
A Mohs procedure is not a simple solution, but with a skilled team and the proper amount of anesthesia, most patients report only minor discomfort. After your surgery, Dr. Evans will be able to give you an idea of whether any reconstruction is necessary and whether it should take place immediately or be delayed until later. After determining that the affected area is cancer-free and reconstruction is necessary, Dr. Evans will review skin cancer reconstructive surgery options with you, which will depend on the size of the tumor, the depth of its roots, and its location.
General anesthesia is not used so you will be able to drive yourself home afterward. Although the site will be heavily bandaged, it is possible to resume routine non-strenuous activities the next day. This rules out any strenuous exercise or heavy activities for up to 1 – 2 weeks. If Dr. Evans applies sutures, they will need to be removed within 6 – 14 days. Scarring will vary, depending on the procedure. We will schedule follow-up visits to monitor your healing and remove any sutures.
Some patients report temporary weakness, numbness, itching, and shooting pains in the treatment area. These should dissipate as you heal. Depending on the aggressiveness of the cancer and the depth of the Mohs surgery, it is possible to acquire some permanent numbness, skin discoloration, or keloid scars. The success rate of removing all of the cancerous tissue from the site with Mohs is very high with primary basal cell carcinomas and squamous cell carcinomas close to 99%. However, two out of five skin cancer patients develop another lesion within five years so follow-up is extremely important.
Frequently Asked Questions
Does insurance cover Mohs surgery?
Since Mohs surgery is almost always a medical procedure, many insurance providers do cover it. If you are considering using your insurance, bring in your information and we will talk with them about your benefits and any out-of-pocket costs. Pacific Skin and Cosmetic Dermatology San Francisco & Marin also accepts multiple payment methods and can help you find medical financing if needed.
How successful is Mohs surgery?
The Mohs achievement rate for eliminating the cancerous tissue from the treated site is very high for main basal cell carcinoma with around a 99% cure rate. Primary squamous cell carcinoma has a bit of a lower rate at around 97%.
Is Mohs painful?
Most of our patients do not report feeling any pain during the surgery because we administer a local anesthetic. You might feel slight discomfort, but it is tolerable. Patients do not typically have pain following the surgery either, but over-the-counter pain medication is recommended for any discomfort.
Will I have noticeable scarring?
Scarring will differ, depending on the size and type of your cancer, the depth of the surgery, and your skin type. Larger and deeper procedures are more likely to leave a scar. However, Dr. Evans will do all she can to minimize scarring as much as possible. For severe or noticeable scars, Dr. Evans might recommend a scar revision procedure after you have fully healed.
Will I need more than one treatment?
Mohs surgery success rates are very high so most patients do not need to undergo a second surgery. However, every case is different. During your initial consultation, Dr. Evans will discuss the likelihood of you needing subsequent treatments.
Receive Superior Care
If you have been given a skin cancer diagnosis, it is crucial that you find a highly trained and experience Mohs surgeon to meet your needs and expectations. Mohs surgery has very high success rates, but these are directly tied to the skill of your surgeon. Call Pacific Skin and Cosmetic Dermatology San Francisco & Marin now schedule your consultation and learn about the experience, training, and personal success rates of Dr. Evans.