Does a Plastic Surgeon Do Mohs Surgery?
No, a plastic surgeon typically does not perform Mohs surgery. Mohs surgery is most commonly performed by dermatologists specially trained in this highly precise surgical technique for skin cancer removal.
Understanding Mohs Surgery and its Purpose
Mohs micrographic surgery is a specialized technique used to treat common types of skin cancer, namely basal cell carcinoma and squamous cell carcinoma. It offers the highest cure rate compared to other skin cancer treatments, often exceeding 99% for primary tumors. This is achieved by meticulously removing cancerous tissue layer by layer and examining it under a microscope until only cancer-free tissue remains.
The Role of a Dermatologist in Mohs Surgery
Dermatologists specializing in Mohs surgery undergo extensive training beyond their general dermatology residency. This includes a fellowship focused specifically on Mohs surgery, microscopic evaluation of tissue samples, and reconstructive surgery to repair the wound after cancer removal. This comprehensive training makes them uniquely qualified to perform the procedure.
Plastic Surgery: Reconstruction After Mohs
While a plastic surgeon generally does not perform Mohs surgery, they frequently play a crucial role after the cancer has been removed. Depending on the size and location of the surgical defect, the dermatologist may refer the patient to a plastic surgeon for reconstructive surgery. This is especially common when Mohs surgery is performed on the face, nose, or ears, where aesthetic outcomes are paramount.
The Mohs Surgery Process: A Step-by-Step Overview
Here’s a simplified overview of the Mohs surgery process:
- Initial Consultation: The dermatologist assesses the skin cancer and determines if Mohs surgery is the appropriate treatment.
- Surgical Excision: The surgeon removes a thin layer of tissue from the cancerous area.
- Mapping and Microscopic Examination: The excised tissue is meticulously mapped, marked, and examined under a microscope to check for cancer cells at the margins.
- Repeat Excision (if necessary): If cancer cells are found, another layer of tissue is removed only from the areas where cancer remains. This process is repeated until all cancer cells are eliminated.
- Wound Closure: Once the area is cancer-free, the wound is closed. This may involve simple sutures, a skin graft, or a flap reconstruction performed by either the Mohs surgeon or a plastic surgeon.
Choosing the Right Specialist
The key takeaway is that expertise matters. If you need Mohs surgery, you should seek out a board-certified dermatologist who has completed a Mohs surgery fellowship. If reconstructive surgery is required after Mohs, your dermatologist may refer you to a board-certified plastic surgeon with experience in facial reconstruction. Knowing the appropriate specialist is crucial for optimal care.
Common Misconceptions about Mohs Surgery
One common misconception is that any surgeon can perform Mohs surgery. In reality, it requires specialized training and expertise. Another misconception is that all Mohs surgery sites need reconstruction. Many smaller defects can be closed directly by the Mohs surgeon.
Comparing Specialties: Dermatology vs. Plastic Surgery
| Feature | Dermatology (Mohs Surgeon) | Plastic Surgery (Reconstruction) |
|---|---|---|
| Primary Focus | Skin Cancer Removal & Diagnosis | Reconstruction and Aesthetic Enhancement |
| Surgical Skills | Highly specialized in micrographic surgery and some reconstructive techniques | Wide range of surgical techniques, including skin grafts, flaps, and scar revision |
| Training | Dermatology Residency + Mohs Surgery Fellowship | Plastic Surgery Residency |
| Scope of Practice | Skin cancer treatment, diagnosis, and management; limited aesthetic procedures | Reconstructive and aesthetic surgery of the face, breast, body, and extremities |
| Relationship to Mohs | Performs the Mohs surgery procedure to remove the cancer. Can sometimes perform reconstruction. | Performs reconstructive procedures after Mohs surgery to repair the surgical defect. |
Frequently Asked Questions (FAQs)
Why is Mohs surgery usually performed by dermatologists?
Dermatologists specializing in Mohs surgery receive extensive training in both the surgical technique and the microscopic examination of tissue. This dual expertise is crucial for accurately identifying and removing all cancer cells while preserving as much healthy tissue as possible. This specific combination of surgical skill and diagnostic capability is why they’re uniquely qualified.
What type of reconstruction might be needed after Mohs surgery?
The type of reconstruction depends on the size, location, and depth of the surgical defect. Simple closures with sutures may be sufficient for small defects. Larger defects may require skin grafts (taking skin from another area of the body) or skin flaps (moving adjacent skin to cover the wound). Complex defects, especially on the face, might require more advanced reconstructive techniques.
How do I find a qualified Mohs surgeon?
Look for a dermatologist who is board-certified and has completed a Mohs surgery fellowship. You can verify their credentials through the American Academy of Dermatology and the American College of Mohs Surgery. Don’t hesitate to ask about their experience and success rates.
What are the advantages of Mohs surgery compared to other skin cancer treatments?
The primary advantage of Mohs surgery is its high cure rate, especially for aggressive or recurrent skin cancers. It also minimizes the removal of healthy tissue, leading to better cosmetic outcomes. Additionally, the real-time microscopic examination allows for immediate confirmation that all cancer cells have been removed.
Is Mohs surgery painful?
Mohs surgery is typically performed under local anesthesia, so you shouldn’t feel pain during the procedure. After the surgery, you may experience some discomfort, which can usually be managed with over-the-counter pain relievers. Your surgeon will provide specific instructions for post-operative care.
How long does Mohs surgery take?
The duration of Mohs surgery varies depending on the size and complexity of the tumor, as well as the number of stages required to remove all cancer cells. Each stage typically takes a few hours, including the excision, processing, and microscopic examination of the tissue.
Does a Plastic Surgeon Do Mohs Surgery if the dermatologist is unavailable?
Generally no, even if the dermatologist is unavailable. Mohs surgery requires specialized training and expertise not typically found in plastic surgeons. In such situations, the patient would likely be referred to another qualified Mohs surgeon.
What are the risks associated with Mohs surgery?
As with any surgical procedure, Mohs surgery carries some risks, including bleeding, infection, scarring, and nerve damage. However, these risks are generally low when the procedure is performed by a qualified and experienced Mohs surgeon. Your surgeon will discuss these risks with you before the surgery.
How is the wound closed after Mohs surgery?
The method of wound closure depends on the size and location of the defect. Small defects may be closed with simple sutures. Larger defects may require a skin graft or a skin flap. In some cases, the wound may be left to heal on its own (secondary intention).
Can Mohs surgery be used to treat all types of skin cancer?
Mohs surgery is most commonly used to treat basal cell carcinoma and squamous cell carcinoma, the two most common types of skin cancer. It can also be used to treat certain other types of skin cancer, such as melanoma in situ.
What should I expect during the recovery period after Mohs surgery?
You should expect some swelling, bruising, and discomfort after Mohs surgery. Your surgeon will provide specific instructions for wound care, pain management, and follow-up appointments. It’s important to follow these instructions carefully to ensure proper healing.
Is it possible to need further treatment after Mohs surgery?
While Mohs surgery has a high cure rate, there is a small chance that the cancer could recur. Regular follow-up appointments with your dermatologist are important to monitor for any signs of recurrence. In some cases, further treatment, such as radiation therapy, may be necessary.