Mohs Surgery
Benefit from a Micrographic Technique Offering the Highest Cure Rate for Skin Cancer in NY
A skin cancer diagnosis can raise many fears and questions. While every patient is unique, there is a highly effective treatment appropriate for most forms of the disease: Mohs surgery. NY’s Hudson Dermatology is home to Dr. Ross Zeltser, a board-certified dermatologist and practice partner who is also one of the first physicians in the world to earn additional board certification in Mohs micrographic surgery. He has performed Mohs procedures for the practice since 2007.
The advanced and specialized technique is designed to completely remove cancerous cells where a lesion has developed. In addition to being extremely effective, Mohs surgery also minimizes trauma to the treatment area, making it ideal for cancers in sensitive and highly visible places. The technique is available for patients coming to Hudson Dermatology’s offices in Fishkill, Kingston, Somers, Tarrytown, and Hudson.
What Is Mohs Surgery?
Mohs surgery is a sophisticated cancer treatment named for its pioneering creator: Dr. Frederic Mohs, professor of surgery at the University of Wisconsin. First developed in the 1930s, Mohs surgery has since undergone many refinements and is now known as Mohs micrographic surgery or simply Mohs surgery.
Because of the extreme precision possible with Mohs surgery, the technique is commonly used to remove cancers in cosmetically sensitive areas (such as on the nose or near the eyes), cancers that are unusually aggressive, or cancers that have recurred after more conventional treatments, such as radiation.
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How Does Mohs Surgery Work?
The Mohs procedure involves surgically removing a small amount of tissue containing and surrounding a tumor in an effort to excise all of the cancerous cells. Because there may be more malignant tissue than is visible to the naked eye, the specimen is prepared, then examined under a microscope. Any edges that still reveal the presence of cancer cells indicate the need for further excisions.
Tissue is removed wherever cancer cells are detected, and a new round of preparation and minute examination begins. This continues until “all margins are clear,” which means no malignant cells are found on any borders. Only healthy, cancer-free tissue will remain.
Once all of the cancer cells have been removed, the wound will be closed with sutures. This is typically handled in the Hudson Dermatology office on the same day as the Mohs surgery itself, but a specialist may need to perform the repair for certain large or cosmetically sensitive wounds. Fortunately, the need for such a specialist will typically be known in advance, so arrangements can be made ahead of time.
Learn more about the procedure and about skin cancer from the American College of Mohs Surgery.
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What Can Mohs Surgery Treat?
Mohs surgery is appropriate for most skin cancers—particularly basal cell and squamous cell carcinomas—and is especially suitable for tumors that develop in an area where it is important to preserve healthy tissue for maximum functional and cosmetic results. It is also ideal for addressing cancers that were treated previously and have come back, are located near scar tissue, are notably large, do not have clearly defined edges, are growing rapidly or uncontrollably, and are an aggressive subtype (such as sclerosing or infiltrating basal cell carcinoma), or develop in lymphoma patients or those who have had organ transplants.
Dr. Ross Zeltser can determine whether Mohs surgery is appropriate in these and other situations.
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Every physician at each of Hudson Dermatology’s seven locations is board certified and committed to providing quality skincare built on a foundation of advanced technology and techniques. All treatments—medical and cosmetic—are highly personalized and chosen for their safety and results.
YOU DESERVE EXCEPTIONAL PATIENT CARE
What Is the Mohs Surgery Experience at Hudson Dermatology in NY?
Dr. Zelster will perform the initial skin cancer removal using local anesthesia. You will then be asked to wait while the tissue is processed and examined under a microscope. This first stage of Mohs surgery can take from one to two hours. If more tissue needs to be removed, this process will need to be repeated until no cancer cells are detected.
Mohs surgery is usually completed in one or two stages, but it can sometimes take several more. We ask that you arrange to be at the Hudson Dermatology office all day, even though most patients are finished within two to four hours.
For most patients, wound closure will be done in the office on the same day. Patients whose closure is happening later will leave the office with a dressing on the wound and an appointment for closure elsewhere the next day—all arranged in advance by our office.
Please know that Mohs surgery, while efficient, can make for a long day. With that in mind, we want to make it as easy as possible for you. There is a television in the waiting room area. Our waiting room and treatment rooms are equipped with HEPA air filters, or you can wait in your car if you prefer. For security reasons, we do not provide public WiFi, but our offices have good cell reception.
Feel free to bring a companion, an extra pillow, reading material, knitting, snacks, or whatever you need to be comfortable. It is even fine to leave the office to do a brief errand or visit a nearby restaurant.
What Happens After Mohs Surgery?
The wound will be dressed, and you will be given specific instructions on how to care for it. There should be minimal pain. We recommend taking Tylenol for any discomfort—and Dr. Zeltser may prescribe pain medication if he anticipates the need.
Mohs surgery procedures on the face or scalp can result in facial swelling and bruising that lasts for several days. Ice packs should help reduce these side effects.
Most patients are able to return to work within one to a few days after their Mohs surgery. Suture removal will be scheduled for about one to two weeks later.
Does Mohs Surgery Leave a Scar?
Mohs surgery preserves as much healthy skin as possible and maximizes options for repairing the surgical defect, once the tumor is completely removed. Once the Mohs surgeon has completely removed your skin cancer through Mohs surgery, reconstruction for optimizing the final functional and cosmetic result becomes the highest priority.
Like any treatment for skin cancer, Mohs surgery will leave a scar.
Generally, a post-surgical scar improves with time and can take a year or more to fully mature. As your surgical site heals, new blood vessels can appear and support the healing changes happening under the surface. This can result in the scar developing a reddish appearance, but this change is temporary and will improve with time.
Note that it is normal to experience numbness in the excision area, as well as occasional tingling or “pin-and-needle” sensations within a healing scar for several months.
In addition, the normal healing process involves a period of skin contraction, which often peaks four to six weeks after the Mohs surgery. This may appear as a bumpiness or hardening of the scar. On the face, this change is nearly always temporary, and the scar will soften and improve with time.
If you have a history of abnormal scarrings, such as hypertrophic scars or keloids, or if there are problems with your scar healing, injections or other treatments may be used to optimize the cosmetic result. The Hudson Dermatology team is available for you throughout the healing process to discuss any concerns that may arise.
What Does Mohs Surgery Cost in NY?
The overwhelming majority of Mohs surgery cases are covered by insurance. You can see a comprehensive list of accepted insurance plans here. Know that, because of Mohs surgery’s high success rate, most patients require only one surgery in order to get their ideal results. Other methods might require additional surgeries and pathology readings in order to repair the wound and treat the cancer if it is not completely removed. Each of these additional surgeries and pathology readings requires a separate fee.
What About Superficial Radiation Therapy (SRT)?
Receiving a skin cancer diagnosis can be emotionally challenging, and choosing the right treatment is crucial. Dermatologists have long had numerous treatment options at their fingertips. At the moment, Superficial Radiation Therapy (SRT) and Mohs Micrographic Surgery are two that are in somewhat opposing corners. Here, we compare these treatments, detailing the pros and cons, and explain why Hudson Dermatology chooses not to offer SRT at this time.
What If I Have More Questions About Mohs Surgery?
The Hudson Dermatology team is always ready and happy to provide answers to frequently asked questions about Mohs surgery. In the meantime, here are some FAQs to cover more about the procedure:
Yes. Following a biopsy, your skin cancer may no longer be visible, but the surface lesion that was removed may have just represented the “tip of the iceberg.” More tumor cells can remain in the skin and continue to grow downward and outward, like the roots of a tree. These “roots” are not visible to the naked eye. If they are not removed, the tumor will likely reappear and require more extensive surgery. The seminal study on this subject was done by Dr. Gary Rogers, who was Dr. Zeltser’s fellowship director.
Tumors that are neglected can spread deep into the skin and even invade nearby structures. On rare occasions, these cancerous cells can metastasize to lymph nodes and other organs in the body.
We suggest that you wear casual, loose, comfortable clothing and avoid wearing anything that must be pulled over your head. Also, please do not wear make-up if the Mohs surgery is on your face.
All Mohs surgery procedures are done with the patient under local anesthesia, so you can eat and drink unless your reconstruction is scheduled at an outside surgical facility under sedation the same day. We suggest that you eat a filling breakfast, since you may have to spend considerable time with us. There will also be opportunities to eat while in the office. Feel free to bring a snack and drinks. For patient safety, there are currently no shared snacks available in the office.
Since Mohs surgery procedures involve only local anesthesia, you will not be drowsy after the session—at least not because of the anesthetic! A driver will not be necessary unless you are told otherwise (due to surgery on the eyelids or sedating medications, for example).
We are able to perform your Mohs surgery safely while you are on these medications. Unless instructed otherwise by another physician, there is no need to discontinue their use.
Please try to stop taking ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) about two days before your Mohs surgery if you are taking them only for minor aches and pains. Acetaminophen (Tylenol) is a good substitute that does not increase bleeding. You may safely stay on your pain medication, however, if you need it to control your arthritis, back pain, or other pain and Tylenol does not work for you. Also, please stop taking Vitamin E. This is to minimize bruising.
Visit the American College of Mohs Surgery website, and please feel free to contact our Mohs surgery coordinator, Zina, at (845) 896-7730 if you have any other questions.
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Residents in the Dutchess, Westchester, Columbia, Ulster, Putnam, Rockland, and Orange County areas can contact the Hudson Dermatology team now to set up a consultation for Mohs surgery in NY.