Mohs Surgery

Mohs Micrographic Surgery

Mohs micrographic surgery is a specialized dermatologic procedure used to treat skin cancer, most commonly used for basal cell carcinoma, squamous cell carcinoma, and other non-melanoma skin cancers. Mohs surgery is often used for skin cancers located in areas where it is important to preserve as much normal tissue as possible, such as the face, hands, feet, or genital area. During Mohs surgery, the skin will first be anesthetized (numbed) using a very small needle and then the dermatologist removes a narrow thin disk of skin containing the cancerous cells. This tissue is then cut into thin layers and each layer is examined under a microscope to determine if any cancer cells are still present. If cancer cells persist, the Mohs surgeon maps the specific location of these cancerous cells and another piece of tissue is taken and examined in the same fashion. This is repeated until no cancer cells remain. This allows the dermatologist to meticulously and precisely identify and remove all of the cancerous tissue while sparing as much healthy tissue as possible, and gives the patient the highest guarantee that the cancer is cured.

Mohs surgery is considered a same-day, outpatient surgery. Patients will not be sedated. The surgery site is numbed with local anesthetic similar to the biopsy. Patients will be allowed to go home the same day after the surgery. We encourage patients to have a driver, although this is not necessary as long as the surgery is not around the eye.

During Mohs surgery at our clinic, patients will be able to remain in their designated surgery room that has a comfortable surgery chair, room for a guest, and a TV. We encourage Mohs patients to bring snacks, drinks, as well as things to pass the time such as books, iPads, computers, and phones.

The Fellowship Difference

A fellowship-trained, board-certified Mohs surgeon is a dermatologist who has received an additional year of focused training in the Mohs surgical technique for the treatment of skin cancer, in addition to a 3-year Dermatology residency.

Fellowship training refers to an advanced training program that a physician completes after completing their residency in dermatology. This training is specifically focused on Mohs micrographic surgery and involves extensive hands-on experience and training in surgical removal of skin cancers, pathologic determination of skin cancer clearance, and reconstruction after successful removal of tumors. 

Board certification is a process in which a physician demonstrates their expertise in a particular field by passing a rigorous examination. A board-certified Mohs surgeon has passed a rigorous certification exam through the American Board of Dermatology in the subspecialty of Micrographic Dermatologic Surgery, thus demonstrating their mastery of all aspects of Mohs surgery and commitment to the highest standards of skin cancer care.

In summary, a fellowship-trained, board-certified Mohs surgeon is a highly trained and qualified dermatologist who has received specialized training in the Mohs surgical technique and demonstrated their expertise through board certification. They are equipped to provide the highest quality of care for patients with skin cancer.

It is important to research and get to know your dermatologist and Mohs surgeon so you know you are in the most capable hands. Dr. Heather Layher is a fellowship-trained, board-certified Mohs surgeon who has performed over 2500 Mohs cases in addition to thousands of excisions. 

View this video from the American College of Mohs Surgery to understand the Mohs process:

Mohs Surgery: The Most Effective Treatment for Skin Cancer





Making a Mohs Surgery Appointment

Patients Looking for a Mohs Surgeon: If you have had a biopsy on the head, neck, hands, feet, or genitals that showed a skin cancer other than melanoma, call our office at (208) 600 - 1330 option 4, and ask to schedule a Mohs surgery appointment. Our team will complete a pre-operative questionnaire over the phone and get you schedule. Please request the doctor who did your biopsy to fax your biopsy result report and the biopsy photo to (208) 567-3523. We do request patients be seen for a pre-operative consultation to best plan the surgery day, however we understand this may not be feasible for some patients located outside of Boise.

Referring Providers: We appreciate the opportunity to assist you in treating your patient's skin cancer! Whether you have already performed a biopsy and confirmed a skin cancer, or you are concerned clinically about a lesion and need it to be biopsied, we can help! Please fax your referral along with the patients chart notes, pathology report, and photos to (208) 567-3523. Our fellowship-trained, board-certified Mohs surgeon will review the pathology and photos to confirm the cancer meets Mohs Appropriate Use Criteria (AUC) and if so, the patient will be scheduled. We do request patients be seen for a pre-operative consultation to best plan the surgery day, however we understand this may not be feasible for some patients located outside of Boise. Please know that when you send patients to our clinic for Mohs only, we will never encourage or suggest they transfer their care to our clinic, and promise to always refer any non-Mohs issues directly back to your clinic.

Post-Mohs Wound Care

Wound care after Mohs depends on if the site was closed with sutures or allowed to heal on its own. For those with sutures, wound care includes gently cleansing in the shower daily, followed by application of Vaseline twice daily until the sutures are removed. For those whose site is healing on its own (secondary intent), wound care includes gently cleansing in the shower daily, followed by a coating of Vaseline to fill the entire wound twice daily until it is fully filled in, which may take 4-8 weeks.

View this video from the American College of Mohs Surgery:

Postoperative Care for Mohs Surgery