Mohs surgery is a specialized, highly effective technique for removing skin cancers. It was developed in the 1930s by Dr. Frederick Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancer tissue so that all roots and extensions of the cancer can be eliminated. Mohs surgery has the highest reported cure rate of all treatments for skin cancer
Treating all skin cancers with Mohs surgery is not necessary. Mohs surgery is reserved for skin cancers that grow back after previous treatment, cancers that are at high risk of recurring, or cancers that are located in cosmetic areas where preservation of the maximum amount of normal skin is important.
Physicians who have the training, surgical and laboratory facilities, and staff to perform this specialized technique practice Mohs surgery. Dr. Kushner received training in Mohs surgery and has used Mohs surgery to treat.skin cancer patients. She is a Member of the American Society for Mohs Surgery.
Some skin cancers are deceptively large-far bigger under the skin than they appear to be from the surface. These cancers may have “roots” in the skin or along blood vessels, nerves, or cartilage. Also, skin cancers that recur after previous treatments may send out extensions deep under the scar tissue that has formed. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous “roots”.
There are three steps involved in Mohs surgery:
1. The skin is made completely numb using a local anesthetic. The visible cancer is removed with a thin layer of additional tissue. This takes only a few minutes, and the patient may then return to the waiting room. A detailed diagram (a Mohs map) of the removed specimen is drawn.
2. The specimen is color coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. These slices are placed on microscope slides and stained for examination under the microscope. This is the most time-consuming part of the procedure, often requiring an hour or more to complete.
3. Dr. Kushner then carefully examines these slides under the microscope. This allows examination of the entire surgical margin of the removed tissue. That is, the entire undersurface and the complete edge of the specimen is examined. All microscopic roots of the cancer can thus be precisely identified and pinpointed on the Mohs map.
4. If more cancer is found on the microscopic slides, Dr. Kushner uses the Mohs map to remove additional tissue only where cancer is present. This allows the Mohs surgery technique to leave the smallest possible surgical defect because no guess work is involved in deciding where to remove additional tissue. Only tissue around the “roots” and extensions of cancer is removed.
Most cases can be completed in three or fewer stages, requiring less than four hours. However, no one can predict how extensive a cancer will be because the size of a skin cancer’s “roots” cannot be estimated in advance. We therefore ask that you reserve the entire day for surgery, in case additional surgical sessions are required.
Yes. Any form of surgery leaves a scar. Mohs surgery, however, will leave one of the smallest possible surgical defects, and therefore a smaller final scar.
When the cancer is removed, Dr. Kushner will discuss with you your options. These may include: 1) allowing the wound to heal naturally, without additional surgery (often produces the best cosmetic result), 2) wound repair by Dr. Kushner, 3) wound repair by the referring physician or making arrangements for wound repair, or 4) referral to another surgeon for wound closure.
Most patients do not complain of significant pain. If there is discomfort, Tylenol is usually all that is necessary for relief. However, stronger pain medications will be prescribed when needed. You may have some bruising and swelling around the wound, especially if surgery is being done close to the eyes.
Most insurance policies cover the costs of Mohs surgery and the surgical reconstruction of the wound. Please check with your insurance carrier for exact information relating to your surgery. Dr. Kushner accepts Medicare assignment for cancer surgery.
Get a good night’s rest and eat normally the day of surgery. If you are taking prescription medications, continue to take them unless otherwise directed. However, avoid taking medications that contain aspirin for ten days before your surgery. Also please do not take any aspirin substitutes, such as Advil, Motrin, Naprosyn, etc. within 24 hours of surgery. You may, however, take Tylenol at any time before surgery. You may want to bring a book or magazine with you to occupy your time while waiting for your slides to be processed and examined. Also, Dr. Kushner recommends that you arrange for someone to drive you home after surgery is completed.
I've been a patient of Dr. Kushner for years now, but I just visited the Farmingdale office for the first time. I had an amazing experience: the office is clean, crisp, and brightly lit. The office staff are friendly and helpful. My wait was negligible and as always, Dr. Kushner addressed my issue in a professional and efficient manner. Highly recommend
I love the accommodations and the heart felt care this office provides there patients. I have a very hectic work and mom schedule and they have always been able to work around my schedule. (Especially weekend office hours) On my most stressfull days with my illness they have always attended with kindness and concern for my care. Pharmacies have always been called the minute you are done with your office visit. Which shows me a prompt and responsible treatment they provide to there patients.
Dr Kushner has always been kind, dedicated and a fantastic doctor. I wouldn’t go anywhere else I took my husband who is in a wheelchair and cannot walk for a small procedure. Dr Kushner was patient and total professional with him Highly recommend Dr Kushner
The lady at the front desk, as well at the PA/MA were so great! I was very pleased with the PA, she was so nice, very honest and professional, specially in this time and date we need more medical professionals like her. I love your practice so much that I brought my daughter there, and made an appointment for my mother too who lives in Queens. Keep up the good work!
Love Doctor Kushner and her staff. I am a new patient and I was very pleased with my visit with her. Very patient, Dr Kushner took her time with me, I did not feel rushed. I love her pleasantness. Her staff is very pleasant and responsive to any questions you may have. Office is clean
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