What is the difference between MOHS dermatologic surgery and plastic surgery for my skin cancer?
If you or someone you know has been diagnosed with skin cancer, it is essential that you understand the role of different physicians in the treatment of skin cancer and your options.
Skin cancer may be diagnosed by any type of physician. This can be a clinical diagnosis where a spot looks suspicious or can be from a biopsy showing actual cancer cells.
Early, skin cancers, referred to as solar keratosis or actinic keratosis can be treated without excision by chemical destruction or freezing or shaving or even topical treatment with 5-Flourouracil. However, if a physician suspects a basal cell, squamous cell or melanoma, surgical excision is recommended. Here’s were things can get confusing to patients.
A dermatologist may refer you to their colleague, a “MOHS surgeon”. These are dermatologists who spend an extra year in an office learning from other dermatologists how to remove skin cancers, interpret the pathology and even attempt to reconstruct the defect! They claim to only remove the actual cancer and not remove any non – cancerous tissue, thereby performing minimally invasive procedures with low recurrence rates. Most of the MOHS then refer the patients back to the dermatologists, completing their symbiotic relationship.
Unfortunately for most patients, MOHS dermatologists are not surgeons. They have no formal surgical training and have never been inside an operating room, except on their surgical rotations in medical school. They are also not board – certified pathologists who have dedicated their careers to reading pathology.
Furthermore, they tend to be very selective on who and what they will treat. Most patients will be sent to them and wait up to 8 hours one day to have the cancer removed. They are then instructed to return to work the next day for the closure and will wait another 8 hours. I have never fully understood why they would make patients spend 2 days and 16 hours to remove a simple lesion I remove in less than 30 minutes with a board – certified pathologist reading the result. One can only assume it has to do with billing and the ability to bill more by separating the procedures over two days. Moreover, if you have more than one skin cancer, you can expect multiple visits. 2 skin cancers will require 4 visits, 3 skin cancers will require 6 etc.
I have seen extremely poor results coming from some of the reconstructions. Defects that should be closed with advanced tissue rearrangements are closed as long, straight lines. Unsuccessful attempts at tissue rearrangement have left deformities. Patients have bled significantly with their open wounds while waiting for “Day 2″ closure and required visits to the emergency room.
My recommendation would be for any patient with a skin cancer to see a plastic surgeon. We are the most highly trained skin surgeons in the world. We can effectively remove all skin cancers and perform reconstructions in one setting. Not only is this more convenient for patients, but also cost – effective. We have board – certified pathologists independently reviewing our specimens. Would you go to a dermatologist for a face lift or a major lacerations?