Mohs
Micrographic Surgery in New Jersey
 It
is our hope that this section will answer many of your questions and
give you a better understanding of Mohs Micrographic Surgery and
the other procedures performed in our New Jersey office. Mohs surgery is a
name applied to a technique developed by Dr. Frederick Mohs in 1936
for the removal of difficult and recurrent skin cancers. It is a
method done under local anesthetic ,in the office in which excision
of a tumor is performed using microscopic control to determine the
extent of the cancer. This microscopic control enables Dr. Connolly
to trace the cancer to its roots and at the same time sacrifice the
least amount of normal, healthy tissue. For this reason, skin
cancers in difficult locations such as the ears , eyelids, fingers,
nose or lips as well as lesions recurring in scars after previous
unsuccessful therapy are best treated this way. Indeed almost all
skin cancers of the head and neck area as well as many on other
parts of the body can benefit from this highly accurate yet
tissue-sparing procedure.
The
number of patients who have been cured clearly demonstrates that Mohs
surgery is the most successful of all methods for the
treatment of skin cancer. Utilizing the Mohs technique, the cure
rate for basal cell carcinoma is usually 97-99% even if other forms
of treatment have failed. Mohs surgery requires highly specialized
training and technology; therefore few medical centers and private
offices in the United States are equipped to offer this highly
advanced therapy. We have four operating suites and a frozen section
laboratory managed by a licensed histology technician in our office
which is located across the street from St. Barnabas Medical Center.
The
Mohs surgical procedure itself involves several steps. First the
suspicious area is numbed with a local anesthetic which we specially
alter to minimize the pain of the injection. A thin layer of tissue
including the obvious cancer is then removed and carefully divided
into small sections. These are marked with colored dyes to
distinguish left and right, top and bottom, made into microscopic
sections, and examined by Dr. Connolly. This takes about an hour
during which time the patient can rest comfortably in our waiting room. If more tumor remains when the tissue is
examined, Dr Connolly is able to pinpoint its exact location in the
patients wound and take more skin only in that precise location.
This is then examined in the same comprehensive fashion and the process
repeated until no more cancer is present. Most of the time, the
surgery is completed the same day even if multiple layers have to be
taken.
When
the Mohs procedure is finished, there will be a wound created. Due
to the conservative nature of the Mohs technique, many of these are
small enough that they heal beautifully without any plastic surgical
repair. If the wound does need reconstruction, this can often be
done by Dr. Connolly in the office the same or next day. If the
wound requires a plastic surgeon to repair it, our office has long,
established relationships with some of the finest plastic surgeons
in the state. Such repairs can often be set up in advance when the
lesions are in cosmetically important areas.
Since
there is much time spent waiting while your tissue is being analyzed,
it is advisable to bring somebody with you to keep you company and
drive you home if you don't feel up to it.
Excisional
Surgery and Repair
Certain
types of skin cancers such as superficial types of melanoma are best
treated not with Mohs surgery but rather with wide, local excision.
In this procedure, the obviously  abnormal
cancer is excised along with a margin of apparently normal skin
whose width is determined by the thickness of the lesion on initial
biopsy. The resultant wound is then manipulated and closed with
sutures in a manner to produce the most acceptable result for the
size and location
Other
Services
Dr.
Connolly is also available for skin examinations in patients at high
risk for skin cancer. He is trained in the use of the
dermatoscope to evaluate unusual pigmented moles and determine which
require biopsies. He can provide excellent referrals for patients
who need more advanced inpatient treatments for more invasive types
of cancer and for those who require radiation after their surgery.
Dr. Connolly is available to help coordinate your care when your
cancer is complex enough to require a team approach for treatment.
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