Mohs Surgery

Annapolis Dermatology Associates offers the latest Mohs surgery techniques, which offer the highest possible cure rates for skin cancer.

Developed by Frederic E. Mohs, M.D. in the 1930s, Mohs surgery is an advanced treatment for skin cancer. Offering the highest potential for complete cure and best cosmetic outcome, it represents the state of the art in skin cancer management.

What is Mohs surgery?

In Mohs surgery, cancerous tissue is isolated and carefully removed from the adjacent healthy tissue. Cancerous tissue is then microscopically examined to trace the cancer in its entirety. Based on the feedback from this examination, which takes place in an on-site, certified laboratory, the surgeon continues to remove tissue or completes the procedure.

With a cure rate of up to 99 percent, even when other forms of treatment have failed, Mohs surgery is by far the best method of tumor removal. It also delivers best cosmetic result. One of the region's most widely recognized Mohs surgeons, Dr. Lisa Renfro is a nationally recognized specialist with extensive knowledge of the skin and skin cancer pathology.

Considering Mohs surgery?

Primarily used to treat basal and squamous cell carcinomas, Mohs is also be used to treat less common tumors. Mohs surgery is usually recommended when:

  • a previously treated cancer recurs
  • scar tissue exists in the area of the cancer
  • it is important to preserve healthy tissue, such as eyelids, nose, ears, lips
  • the cancer is large
  • the edges of the cancer cannot be clearly defined
  • the cancer grows rapidly or uncontrollably

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How effective is it?

Mohs surgery has the highest cure rate of any known skin cancer treatment: 99 percent overall, and 95 percent for recurrent cases. It allows the best cosmetic outcome and preserves the maximum amount of healthy tissue. Effective for many types of skin cancer, Mohs is most frequently used to treat basal cell and squamous cell carcinomas.

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How is it performed?

Mohs surgery is performed in our surgical suite under local anesthesia. The process includes a specific sequence of surgery and pathologic investigation. First, Dr. Renfro surgically excises the tumor with a narrow margin. The tissue is then processed in the onsite histotechnology laboratory where it is color coded with tissue dyes. A precise map of the tissue is made and then the tissue is analyzed microscopically to determine if the margins contain any remaining cancerous cells. If any cancer remains, another thin layer of tissue is removed, only from the specific site where the tumor cells were still present. This procedure is repeated until the cancer is completely removed.

This selective removal of only diseased tissue allows preservation of much of the surrounding normal tissue. Because this systematic microscopic search reveals the deepest extensions of the skin cancer, Mohs surgery offers the highest chance for complete removal of the cancer while sparing the normal tissue. Cure rates exceed 99 percent for new cancers, and 95 percent for recurrent cancers.

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Where is the surgery performed?

Surgery is performed in our onsite Joint Commission accredited and Medicare certified ambulatory surgery facility. Our patients experience the highest level of outpatient care.

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How long does it take?

The removal of each layer of tissue is brief, requiring approximately 15-20 minutes. The processing and microscopic analysis of each layer of tissue requires approximately one to two hours. Most skin cancers are removed in one to two layers. A Mohs surgical case begins in the morning and is generally completed in several hours.

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What about healing?

The best method of managing the wound resulting from surgery is determined after the cancer is completely removed. When the final defect is known, management is individualized to achieve the best results and to preserve functional capabilities and maximize aesthetics. Dr. Renfro is also trained in reconstructive procedures and will usually perform the reconstructive procedure necessary to repair the wound. A small wound may be allowed to heal on its own, or the wound may be closed with stitches, a skin graft or a flap. If a tumor is larger than initially anticipated, another surgical specialist with special skills may complete the reconstruction.

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Patients can learn more about Mohs surgery, including what the Mohs procedure is, see the Mohs step-by-step process, and answer to the most-asked questions about the procedure.

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Pre-surgery dos and don’ts

Do:

  • Consult us if you are taking any blood thinners such as: Plavix, Coumadin (Warfarin), Ticlopidine, Warfarin, Pradaxa, Jantoven, Fragmin (Dalteparin), Pletel (Cilostazol), Eliquis (Apixaban), Xarelto (Rivaroxaban), or any other medications on the following list.
  • It is best to refrain from airline travel until the sutures are removed.
  • Take a thorough bath or shower and wash your hair the night before surgery.
  • Use antibiotic soap on the surgical site for three days before surgery. (i.e. Lever 2000, Dial antibacterial, Hibiclens).
  • Wear comfortable clothing. If your lesion is on your head, neck or trunk, it is helpful to wear a top that zips, snaps or buttons.
  • Bring a ginger ale, large bottle of water or juice to drink and a light snack to eat while you are with us.
  • Get a good night’s sleep.
  • Take your regular medications as you usually do, unless told otherwise by our office.
  • Eat a light breakfast the morning of surgery.
  • If possible, bring someone to drive you home.

PLEASE DO NOT TAKE ASPIRIN or anything else on this list ten days before and five days after surgery, unless your medical doctor or cardiologist has told you to take it. If your doctor has told you to take anything in this list, please discuss with our office.

If you are planning to take any over-the-counter medications prior to surgery, please ask the pharmacist whether he can recommend one that contains no acetylsalicylic acid or ibuprofen.

Do Not Take:

Aspirin (acetylsalicylic acid) containing drugs:

Aggrenox, Alka-Selzter, Anacin, Arthritis Pain, Ascriptan, Bayer, Bufferin, Cold Medicine, Coricidin, Dristan, Easprin, Ecotrin, Excedrin, Fiorinal, Midol, Pepto-Bismol, Percodan, Sine-Off

Aspirin-like drugs:

Advil, Aleve, Anaprox, Ansaid, Clinoril, Daypro (Oxzprozin), Effient, Enbrel, Feldene, Ibuprofen, Indocin, Lodine, Mobic, Motrin, Nalfon, Naprosyn, Nuprin (ibuprofen), Orudis, Relafen, Toradol, Voltaren

Nutritional Supplements:

Alfalfa , Fish Oil, Omega-3, Bilberry, Flax Seed Oil , Papaya, Cayenne , Garlic, St. John's Wart, Chamomile , Ginger, Valerian, Chromium, Ginko biloba, Valerian Root, Dong quai , Ginseng , Vitamin E, Echinacea , Hydroxycut, Yohimbe, Ephedra , Kava kava, Feverfew, Licorice Root

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The Best

D.C.

My experience with Annapolis Dermatology Associates was outstanding!!

M.J.

As usual, everything at this facility is done in an outstanding and totally professional manner.

E.W.

Dr. Renfro and the nurses were extremely courteous, informative and professional. They made you feel at ease.

R.S.

Dr. Renfro and crew – Excellent procedures and bedside manner

J.B.

Great Team!!

D.S.

Everyone was so nice and reassuring! Dr. Renfro was very nice and treated me like I was her only patient!

L.G.

Staff is consistently knowledgeable, friendly and courteous. Always a positive experience.

G.W.

Thank you for making my surgical procedure so easy!

R.W.

Perfectly professional.

A.L.

Consistently superior over the 20+ years I’ve been using this practice. Keep up the great effort.

T.H.

Many, many years of always top-notch, professional care. Thank you so much!

T.B.

Jim and staff are great! Beautiful facility.

Beautiful and well-appointed office. I was impressed with every aspect, from the desk staff to the doctor.

D.W.

Service and assistants’ attentiveness is one of the best I have received in any medical facility I have experienced.

Excellent as always.

J.B.

The team was very professional. It was a great experience – well done!!!

Christine was an amazing PA.

S.O.

A fantastic experience.

This is the most professional medical practice I have ever had the pleasure to use. I cannot thank Dr. Renfro enough.

B.C.

Dr. Renfro was extremely competent.

R.D.

Kudos to Dr. Renfro and her staff.

L.W.

Outstanding care by all involved – Dr. Lanuti and staff

M.F.

EVERYONE is kind, welcoming, attentive and professional.

M.K.

Best doctor visit in 56 years. Painless and fun.

M.K.

Jim Heins and your entire staff are awesome! A+ Jim is patient, professional and friendly.

Jim Heins is outstanding. He is friendly, thorough and an excellent P.A. Thanks

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