What is Micrographic Surgery?

Micrographic surgery is a very specialized way of treating skin cancers. It provides the highest possible cure rate while removing as little normal skin as possible. Micrographic surgery is also called Mohs surgery in honor of Dr. Frederic Mohs who developed the technique.

The procedure begins by thoroughly numbing the area with a local anesthetic. Then all visible cancer is removed, and a very thin layer of surrounding skin is taken to check for any remaining cancer cells that are otherwise invisible to the naked eye. This layer is processed by a technician and examined under the microscope by the micrographic surgeon. The location of any remaining cancer is carefully mapped on a diagram of the surgical wound and then removed in a thin layer. The tissue is also examined under the microscope, and the process is repeated as often as necessary until all the cancer cells have been completely removed.

By using these detailed mapping techniques and complete microscopic margin control, the micrographic surgeon is able to locate and remove even the smallest microscopic cancer roots without sacrificing large and unnecessary amounts of normal, uninvolved skin.

What are my chances for cure?

Micrographic surgery offers the highest available cure rate of all skin cancer treatments. Over 96% of skin cancers are cured following micrographic surgery, even if other forms of treatment have failed. Other methods of treatment average only 60% cure rate if previous treatments have failed.

Will I be hospitalized?

No. Micrographic surgery is performed in an outpatient surgical suite, and you may return home the same day.

What happens on the day of surgery?

Your appointment will be scheduled early in the day. Our staff will escort you into a surgical suite where the medical staff will numb the area around the skin cancer. Once the area has been numbed, the visible cancer and a thin layer of tissue will be removed. This tissue is carefully mapped and coded by the surgeon and taken to the adjoining laboratory where the technician processes the microscopic slides. You will have a temporary dressing placed over the wound and will be free to return to the waiting room.

The surgical procedure only takes 10-15 minutes. However, it takes a minimum of 1-2 hours in the laboratory to process and examine the tissue. You will be asked to wait in the waiting room while the laboratory work is being done. If remaining cancer is found, you will be brought back to the surgical suite and a second thin layer will be taken from that area. This will also be taken to the laboratory for processing while you wait. Although there is no way to tell before surgery how many stages will be needed, most cancers are removed in three stages or less.

Waiting for results from the laboratory can be long. We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material and snacks to occupy your time.

Since we do not know in advance how much time will be needed to remove the cancer and repair the wound, we ask that you make no other commitments for the entire day that you are scheduled for surgery.

Will I have pain after surgery?

Most patients do not complain of significant pain. If there is any discomfort, Tylenol is usually adequate for relief.

Will the surgery leave a scar?

Yes. Any form of skin cancer treatment will leave a scar. However, because micrographic surgery removes as little normal tissue as possible, scarring is minimized. After the cancer is removed, we may choose to (1) let the wound heal by itself, (2) repair the wound with stitches, or (3) reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic results. A repair or reconstruction may add 1-3 hours to the surgical day, but if indicated can also improve cosmetic outcome.

Preparing for Surgery

Medications

Continue any medications prescribed by your doctor. Aspirin however is a drug that may prolong bleeding. We ask that you avoid aspirin (including Anacin, Bufferin, Excederin, Alka Seltzer, and Percodan) for at least a week prior to surgery. Also, avoid ibuprofen (Motrin, Advil, Nuprin) for one day prior to surgery. You may take Tylenol any time before surgery, if needed for pain.

If you have been prescribes blood thinners, we do not require you to stop taking them. However, if you are concerned about bleeding and the effect that will have on the surgery, please contact the provider who prescribed the blood thinners to determine if stopping the medication poses a significant health risk for you.

In addition, alcohol will increase bleeding, so avoid alcoholic beverages for at least 24 hours before surgery.

Cosmetics: 

Do not wear any cosmetics or perfume when scheduled for a check up or facial surgery.

Transportation: 

We suggest that you arrange to have a companion drive you to and from the office the day of your surgery

Eating: 

the day of surgery, we suggest that you eat a normal breakfast.

Arrival:

Please plan to arrive fifteen minutes early so that we may complete your medical record and obtain necessary insurance information.

Insurance Information

Micrographic surgery is covered by most major insurance carriers. We also accept assignment on Medicare. This means that we agree to accept their approved fee. You or your secondary insurance carrier is responsible for the remaining 20%.
We will submit a claim to your insurance company for you. Please bring any necessary insurance information (including the mailing address of your insurance company) with you to your visit. You will also be responsible for any deductibles or co-payments required by your insurance on the day of your surgery.

Micrographic Surgeons

Dr. Pena completed her pathology and dermatology residency programs at The University of Florida College of Medicine and at Southern Illinois University, respectively. Additionally she received surgical training under the direction of Mohs Micrographic surgeon Dr. Robert Buzzell.

Dr. Tidwell completed his residency at the University of Louisville and Mohs surgery fellowship at Scripps Clinic in La Jolla, CA. Additionally, he trained under Dr. Rex Amonette at the University of Tennessee Medical School in Memphis, TN.

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