Mohs Surgery in Marin & San Francisco, CA

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.

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.

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.

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. 

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.