Mohs Surgery Specialists | Top Mohs Surgeon

As researchers continue to grapple with finding new and better ways to treat cancer, one treatment stands out as one of the most promising tools to fight skin cancer: Mohs micrographic surgery (MMS). Though it’s been around since the 1930s, when Dr. Frederick Mohs first introduced the technique, surgeons only began to embrace this procedure in the 1990s. Your Manhattan dermatologist agrees that Mohs skin cancer surgery is an exceptional technique that can lead to quick and thorough cancer diagnoses and treatments.

Dr. Bard is among the best-rated Mohs surgeons in the country. She is fully trained and extensively experienced at using in-office skin cancer treatment. Your local expert in skin cancer surgery is prepared to perform this procedure at our dermatology clinic.

Mohs micrographic surgery (MMS) has become the standard of care for the treatment of high-risk nonmelanoma skin cancers. It is increasingly used to treat melanoma. This type of skin cancer treatment has the highest cure rates, saves the maximal amount of normal tissue.

Prior to the development of the modern Mohs surgical procedure, you had to wait to hear back from a laboratory to find out the results from a skin biopsy. If your dermatologist removed a piece of an unknown skin lesion, the lab would determine if the skin sample was benign (non-cancerous) or malignant (cancerous). You also may have had to return for multiple excisions before your dermatologist could be sure that all the cancerous skin cells were removed. This type of surgery eliminates the guesswork in treating skin cancer. MMS allows your New York Mohs surgeon or your local dermatologist to scrape away tiny slivers of your suspicious growth and, to use a simple microscope in the office, determine whether the slice of skin contains residual malignant cancer cells.

Mohs Skin Cancer Surgery Has a Low Recurrence Rate. Multiple observational studies have consistently demonstrated that this procedure has a low recurrence rate often much lower than surgical excision. According to a study published on pubmed “Mohs micrographic surgery (MMS) in the treatment for cutaneous basal cell carcinoma (BCC)”, out of 3370 patients enrolled (1594 female and 1776 male patients, 56% primary tumors and 44% previously recurrent tumors). Recurrence at 5 years was diagnosed in 1.4% of primary and in 4% of recurrent tumors.

Mohs surgery specialists recommend this type of procedure to patients with common skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). It is also used as a skin cancer treatment for certain kinds of melanoma and other more unusual skin conditions.

The surgery for skin cancer is especially useful for patients with tumors that:

• Have a high risk of recurrence
• Are large or aggressive
• Located in areas with little tissue beneath, such as eyes, nose, mouth, ears, scalp, hands, feet, and genitals)
• Don’t have clearly defined borders.

Indications for Mohs surgery either alone or as part of an overall treatment approach include the following:

• BCC (Basal Cell Carcinoma)
• NMSC (Nonmelanoma Skin Cancer)
• SCC (Squamous Cell Carcinoma)
• Basal cell nevus syndrome
• Cutaneous tumors:
• Keratoacanthoma (KA)
• Dermatofibrosarcoma protuberans (DFSP)
• Microcystic adnexal carcinoma (MAC)
• Atypical fibroxanthoma (AFX)
• Melanoma
• Other rare tumors (Angiosarcoma, Sebaceous gland carcinoma, Extramammary Paget’s disease, Malignant fibrous histiocytoma, Leiomyosarcoma, Adenocystic carcinoma, Apocrine or eccrine carcinoma, Merkel cell carcinoma)

Skin cancer surgery is also used to treat certain rare conditions such as DFSP, extramammary Paget’s disease, and Merkel cell carcinoma. Regardless of the type of skin condition you have, Mohs skin surgery is only recommended for certain patients. You must only have one or several skin cancers that are very close together.

Having any type of skin surgery can be intimidating. However, if your nearby dermatologist or surgeon specialist Dr. Bard recommended Mohs micrographic surgery, you can take comfort in knowing that it has a very high cure rate. Your dermatologist will only remove the minimal amount of skin needed to treat cancer.

Excision for MMS is performed in several steps. First, a thin layer of cancerous tissue is removed, then the second layer of tissues is removed and viewed under a microscope for the purpose of checking for cancer cells. More layers are removed one at a time until the tissues viewed under a microscope depict no remaining cancerous cells. Conventional excision is considered standard treatment though randomized trials with long-term follow-up are rare. These excisions may be regarded as the optimal treatment of basal cell carcinomas. During conventional excision, a larger amount of tissue is taken at once, resulting in more scars than you would have with Mohs micrographic surgery. Moreover, in traditional excision, only 1 percent of the edges are examined under a microscope.

After numbing the area with local anesthesia, your doctor, or your laser and Mohs dermatologist in NYC, Dr. Bard removes a thin layer of skin from the growth and from surrounding margins. Viewing it under a microscope, it’s possible to discern if the margins are completely clear of cancer. If so, then that’s the end of the treatment. If, however, some cancer cells are still present in the surrounding skin, Mohs specialist Dr. Bard can scrape away one layer at a time until all the malignant cells are removed. The procedure may take hours, but the targeted lesion will be cancer-free by the time you leave. Dr. Bard is accepting patients for Mohs micrographic surgery in our advanced skin and Mohs surgery center located in Midtown, Manhattan & Upper East Side, New York. Dr. Susan Bard is a leading Mohs dermatologist with additional training in the field of MMS, skin cancer management, and dermatological surgery. This procedure is done in stages in one visit while the patient waits.

• Examination and preparation
• Top layer removal
• Lab analysis
• Microscopic examination
• Second layer removal
• Wound repair
• Finishing up

Slow Mohs surgery that is performed by the leading dermatologist Dr. Bard in our New York laser clinic is a slightly modified version of the breakthrough Mohs Micrographic Surgery procedure. It’s primarily used to treat lentigo malignant melanoma, a form of deadly skin cancer that appears in the epidermis and accounts for about four percent of all melanoma cases. Lentigo maligna melanoma often presents on your neck or face, particularly on your cheeks or nose — the spots where sun damage is most prevalent.

Instead of getting instant results in the office, the slow MMS surgery, as the name suggests, requires more time. Layers of skin are rushed off to a pathologist for overnight results. The margin-controlled excisions are taken in stages, and cosmetic repair is reserved until the final results are in. Slow MMS surgery is ideal for older patients, who most likely suffer from lentigo maligna melanoma anyway.

Mohs surgery melanoma discoveries have led to a 98 percent recovery rate when performed in the early stages of cancer. While Mohs skin surgery is not the only treatment available for skin cancer, nor is it always the most judicious, it is ideal when the cancer is in a place that may drastically affect your appearance.

Call to schedule an appointment with the leading New York City Mohs surgeon Dr. Bard to find out if this laser dermatology procedure is suitable for you. Having a Manhattan dermatologist highly trained in Mohs surgery skin cancer treatment is a boon when you need it. And a cosmetic dermatologist is better able to provide you with the cosmetic follow-up to assure you that you won’t have a noticeable surgery scar after the procedure. This type of skin cancer surgery procedure removes the least amount of skin and leaves the smallest scar, as compared to other surgical excision options.

Typically, you have little if any pain following the procedure. Any discomfort can be taken care of with over-the-counter pain relievers. Excessive bleeding is rare, too; holding a gauze pad over the affected area for 15 minutes is usually sufficient to tide any blood flow. While complications are rare, call your best Mohs surgeon in NYC, Dr. Bard, immediately if you experience chills, fever, swelling, increasing redness, or severe pain following this procedure.

Minor complications after Mohs procedure that disappear over time include:

• Bruising or swelling that lasts for up to five days, especially if the procedure was performed around your eyes. As Mohs surgery aftercare, use ice packs to help minimize swelling.
• Red skin surrounding the surgical spot, which is common and does not necessarily indicate the presence of an infection
• Itching around the sore, which is also common, especially around the area where the adhesive tape was used to block off an area of your skin
• Numbness, which may last for months — if the feeling doesn’t return after several months, there is a chance that it will be permanent.

According to multiple studies, large tumors are at higher risk for complications following skin cancer surgery due to their increased size and need for repair with methods other than linear closures.

If you’re in poor health or can’t tolerate procedures that rely on local anesthesia, the MMS may not be right for you.

Alternatives to Mohs surgery include:

• Excision. This technique is common for basal cell carcinoma. Your dermatologist cuts out the offending tissue and a small margin of skin surrounding the tumor.
• Radiation. This is a more drastic option but effective, especially if you can’t tolerate local anesthesia or if the tumor is located in a hard-to-reach area such as the edge of your ear or on your eyelid.
• Cryosurgery. This technique involves freezing the tumor. It’s best for small cancerous growths. Cryosurgery can take a month or more to be completed.
• Topical medication. This technique is often reserved for superficial tumors. You usually perform this at home by applying a medicated cream to the growth every night until it disappears.