A Closer Look at Mohs Surgery

Learning that you have skin cancer is unsettling. Sun exposure has taken its toll on your skin, and now you need to do something about it. But you want to be sure that treatment will be effective. 

There are different procedures for removing skin cancers. While all of the procedures are highly effective, Mohs surgery is the most effective surgical treatment for basal and squamous cell skin cancers, and it can be used for melanomas that have only affected the top layer of skin. 

Not all dermatologists perform Mohs surgery. At Seacoast Dermatology, board-certified dermatologist James Dinulos, MD, is our Mohs surgeon and performs this type of surgery frequently. 

When is Mohs surgery indicated? 

If you’ve developed skin cancer in places where the skin is delicate, thin, and important to your  appearance, such as your eyelids, nose, lips, ears, scalp, fingers, toes, or genitals, Mohs surgery is the gold standard. Skin cancers in those areas are considered high risk. 

Mohs is also indicated in the following cases of skin cancer: 

• Large tumors in areas of low risk
• Cancers with ill-defined borders
• Cancers with specific growth patterns that can be seen under a microscope
• Cancers that recur after being treated
• Cancers that were not completely eradicated previously

Basal cell and squamous cell superficial skin cancers on the abdomen, chest, back, arms, and legs are evaluated and often surgically removed by other methods. 

Special training for dermatologists

Dermatologists who perform Mohs surgery receive special training. Removing cancer isn’t their only role. They’ve been trained to act as a pathologist for this procedure. Dr. Dinulos himself examines the specimen under a microscope to determine if the sample is cancerous.  

The Mohs procedure

If you have Mohs surgery, bring a book or ebook with you. You’ll have periods of waiting when tissue samples are being prepared and examined in the office lab.  

Our surgical team disinfects the target area thoroughly. You’re awake during your procedure, but don’t worry: You don’t feel pain once you receive an injection of anesthetic at the site of the surgery. 

Dr. Dinulos removes the area of skin where the skin cancer is visible. For example, if you had a patch of raised, scaly brownish skin on your finger or scalp, he takes a very tiny amount of the skin surrounding the patch and then places a bandage on it. 

You’re free to read on your phone or simply rest while Dr. Dinulos examines the sample under the microscope. He divides the tissue into separate areas and codes them with dye. 

A staff member freezes the tissue. Once frozen, the tissue is sliced into horizontal layers. Each slice is placed on a slide and stained.

If Dr. Dinulos still sees cancer, he removes additional skin surrounding the target area, and again reviews the sample under the microscope. He repeats the process until he sees no more cancer. Dr. Dinulos may need to use stitches to close the wound, although some wounds don’t require it. 

Skin cancer can be scary, but surgery to remove it is very effective. Contact one of our four Seacoast Dermatology locations to book your appointment for expert skin cancer treatment. Our offices are in Portsmouth, Exeter, and Dover, New Hampshire.