Mohs Procedure | Mohs Surgery | Mohs Micrographic Surgery

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"Patients' Choice Award" by Vitals.com

Dr. Sam Naficy has been awarded the "Patients' Choice Award" by Vitals.com - a website dedicated to rating the quality of physicians across the country. Out of 720,000 physicians, only 5% received this honor.

Mohs Surgery

Mohs (also known as Mohs micrographic surgery, Mohs excision, Mohs removal, or simply Mohs surgery) is a technique for removal of skin cancers. The name Mohs comes from the name of the physician, Dr. Frederick Mohs, who developed the skin cancer removal technique decades ago. Mohs is typically performed for basal cell carcinoma and squamous cell carcinoma of the face. Simply stated, the Mohs technique is a method of removing skin cancers that confirms complete removal of the skin cancer by examining all of the margins of the removed tissue under the microscope. The Mohs specialist thus serves the role of both removing the skin cancer and making the pathology diagnosis of whether all the cancer has been removed.

The Mohs removal is performed by a specially trained group of dermatologists known as Mohs specialists. Mohs reconstruction of the skin cancer defect can either be performed by a plastic & reconstructive surgeon or by the Mohs specialist, depending on patient preference and on the location and complexity of the defect.

Mohs Procedure

The Mohs procedure starts by numbing the skin cancer and surrounding skin by injections of local anesthesia. The skin cancer is removed in one piece and the underside of the removed tissue is mapped (divided into regions). The tissue segments are then frozen and thinly sliced, placed on glass slides, and stained for examination under the microscope. The Mohs specialist then examines the removed skin cancer tissue checking to see if there is any skin cancer present at the edge of the removed tissue. This processing and examination of the tissue is performed in an expeditious manner, typically over an hour, during which time the patient waits in Mohs specialists' office.

If skin cancer is found at the edge of the removed tissue, then more tissue is removed from the wound and the entire process (called a Mohs stage) is repeated until all margins are found to be clear of skin cancer at which point the patient is ready for reconstruction (repair) of the Mohs defect.

Mohs Reconstruction

Dr. Sam Naficy specializes in aesthetic reconstruction of facial defects after Mohs surgery. The majority of Mohs defects are on the face and many of those are on the nose and lip areas where skillful reconstructive surgery is required to avoid a significant cosmetic deformity. Mohs defects can range in size from 6 mm (size of a pencil eraser head) to over 10 cm (four inches) in size. The majority of Mohs defects are repaired in an outpatient setting under IV sedation. Depending on the size, location, and complexity of the Mohs defect, additional reconstructive procedures may be required to produce the best cosmetic result.

Nose Reconstruction

Reconstruction of the nose is one of the most challenging aspects of plastic surgery. The nose is a three dimensional structure made up of not only skin, but also muscle, cartilage, and bone. Aside form its cosmetic importance; the nose serves a vital function in breathing, smell, and taste. Dr. Naficy has been performing complex nasal reconstruction procedures for nearly 15 years and has written a textbook on nasal reconstruction after Mohs. Click here to view more photos of nose reconstruction performed by Dr. Naficy.

Before After Nasal reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma

Lip Reconstruction

Lips are also common sites for occurrence of skin cancers. Basal cell cancers typically occur on the upper lip whereas squamous cell cancers occur on the lower lip. Lips serve a vital role in cosmetic beauty of the face and are an important functional structure for speech, chewing, and swallowing. Click here to view more photos of lip reconstruction performed by Dr. Naficy.

Before After Lip reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma

Cheek Reconstruction

Cheeks are also common sites for occurrence of skin cancers and in particular for certain types of melanomas such as lentigo maligna. Cheek defects often encroach on the skin of the lower eyelids and one of the biggest reconstructive challenges in cheek reconstruction is to avoid distorting the lower eyelid. Click here to view more photos of cheek reconstruction performed by Dr. Naficy.

Before After Cheek reconstruction by Sam Naficy, MD following removal of a lentigo maligna melanoma

Forehead & Temple Reconstruction

Reconstruction of defects involving the forehead and temple area can be quite challenging since this region has fairly stiff skin with not a great deal of laxity. Also one needs to take measures to avoid distortion of the eyebrow, which can at times occur if the skin cancer defect is in proximity to the brow region. Click here to view more photos of forehead and temple reconstruction performed by Dr. Naficy.

Before After Forehead reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma

Mohs Advantages

The main advantages of the Mohs technique are the following:

• Mohs allows for examination of all margins for residual cancer and thus has the highest cure rate
• Mohs allows for maximal tissue preservation, meaning that no more skin is removed than necessary
• Mohs is typically performed under local anesthesia and no IV sedation or general anesthesia is required

Mohs Disadvantages

The main disadvantages of the Mohs technique are the following:

• Mohs is a lengthy procedure, often requiring hours to complete
• Often times, for scheduling reasons, the plastic surgery reconstruction of the Mohs defect needs to be performed on a different day
• Mohs is typically performed under local anesthesia and no IV sedation is available.

Scheduling Mohs

If you have a facial skin cancer and are interested in scheduling the Mohs procedure you may contact us to initiate the scheduling process. We can help set up the Mohs procedure for you as well schedule you with Dr. Naficy to perform the reconstruction of your Mohs defect.

Dr. Naficy works in tandem with a number of fellowship trained Mohs specialists in the Seattle and Bellevue area. Dr. Naficy's nursing staff will schedule your Mohs procedure at a convenient time and location. The reconstruction of the Mohs defect by Dr. Naficy is typically performed on the day following the Mohs removal but may at times be scheduled on the same day, typically later in the afternoon.

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