Timothy L. Parker, MD
Thomas L.H. Hocker, MD

Advanced Dermatologic Surgery

Mohs Surgery

Mohs surgery is a highly specialized treatment for the removal of skin cancer. Developed by Dr. Fredric Mohs, this method involves microscopic examination of the surgically removed skin tissues as well as detailed mapping techniques.

By using this technique along with complete microscopic control, our physicians can pinpoint areas with cancer that are otherwise invisible to the naked eye; therefore, even the smallest roots of cancer can be removed from the skin with minimal sacrifice of healthy skin. The result: minimal removal of healthy tissue with the highest possible cure rate.

Our physicians perform Mohs surgery in a pleasant office procedure room at Advanced Dermatologic Surgery, and the reconstruction portion is performed in an operating room in the adjacent, state licensed, Medicare-approved ADS Ambulatory Surgery Center. In this manner, we are better able to provide for your safety, and you may return home the same day.

The percentage of cure using Mohs surgery by a fellowship-trained Mohs surgeon is more than 99% for most skin cancers, even when other forms of treatment have failed. Other methods of treatment only offer a 50% chance of success if previous treatments have failed.

Preparing for surgery
Once your physician or provider has contacted us and we have received and reviewed the necessary paperwork, your appointment for surgery will be scheduled for early in the morning, and we will advise you as to what time you need to arrive (usually around 7:30 to 8:30 a.m.) We will send a packet of information to you including information about Mohs surgery, a map with directions to our office, plus some forms that you will need to complete and bring with you on the day of your appointment. Additionally, most of those forms are available for download under thePatient Forms button of this site.

Carefully filling out all of your paperwork, especially each section of the medical history form, the patient information form, and authorization forms will save you considerable time when you arrive the morning of your appointment. Please note, due to new identity theft laws, you must also have your insurance card(s) and a photo i.d. with you when you check in. If you do not possess one or both of these, please contact our office prior to the morning of your surgery for specific instructions.

The day of surgery
When you arrive for your appointment, you will be greeted by our front office team, and we will verify that you have all necessary paperwork completed. You may also be asked to sign some additional consent and privacy forms.

During this brief time, you will be invited to sit in a comfortable waiting area where you may enjoy some coffee or water. You will then be escorted into a procedure room where one of our clinical staff members will discuss your health history with you, and answer any questions you may have about the procedure.

Your physician will then meet with you to discuss your treatment options, and he will perform an examination. Once you are in agreement that Mohs surgery is the best option, the skin cancer and the surrounding area will be numbed with a local anesthetic, which usually contains an antibiotic, Clindamycin. Once the area is numb, the visible cancer and a thin layer of surrounding tissue will be removed. This tissue is carefully mapped and coded by our physicians, and is taken to our laboratory where the technician will immediately process the microscope slides.

You will have a temporary dressing placed over the area, and you will be escorted to one of the surgical waiting rooms. The surgical procedure takes approximately 20 minutes; however, it takes a minimum of 1 hour to prepare and microscopically examine the tissue. Multiple surgical stages and microscopic examinations may be required, and you will need to stay in the surgical waiting area between stages. Although there is no way to tell before the surgery how many stages will be necessary, most cancers are removed in three stages or less. Most patients are here between 3-6 hours. The repair stage of the surgery usually will begin late morning or early afternoon.

Many patients find that the most difficult part of the procedure is waiting on the result. So to make the time you spend with us as pleasant and comfortable as possible, we provide books, magazines, flat screen cable-TV, small board games, coffee, tea, soft drinks and snacks. A microwave and a small refrigerator are located in one of the surgical waiting areas. Please feel free to bring your own reading materials, small hobby or craft items, business paperwork, etc. if you so desire. Our office also has Wi-Fi available for your laptop, tablet or smart phone.

Visits often extend through the lunch hour, so we encourage you to bring a lunch with you since you will be required to remain in the surgical waiting area until all procedures are completed. Alternatively, your companion may leave to get lunch for you at any of the nearby restaurants. Because this is a surgical waiting room with other patients, we kindly ask that each patient only have one companion with them on the day of surgery.

Helpful links
For more information on Mohs surgery, the different types of skin cancer, causes of skin cancer, how to prevent skin cancer, sunscreen usage and more, the following links are very helpful:

The American College of Mohs Surgery

The American Society for Dermatologic Surgery

The American Academy of Dermatology

Patient Education