Dr. Mohs was a general surgeon who invented a technique which evaluates the entire surface of a tumor excision. He started by evaluatig the lesion as if it were a clock. Following the excision of the lesion, he used different colors apllied to the skin surface in the different quadrants of the clock and shaved the entire margin of the lesion. This made it possible to evaluate the entire length of the skin edge under the microscope and tell the location of the remaining cancer by looking at the surface of the skin for the color. After all, the color at the location of the cancer would tell you in which quadrant it was located. After the evalution of the stage was complete, he would make a map of the lesion and the remaining cancer, called a "Mohs map". By removing only those parts of the skin containing cancer cells, he was able to remove all the cancer reliably without sacrificing normal skin. This made the reconstruction of the resulting skin defect easier.
The preparation and examination of the lesion after the excision is performed in a "Mohs lab"by a Mohs technician. The Swier Clinic has a certified Mohs lab and several skilled Mohs technicians. Dr Swier will evaluate the skin margins using a microscope and he has a Pathologist on standby if needed. After an internal audit, our recurrence rate was 1 in 3,000, which is substantially lower than the national average of 1-5%.
The entire process takes about 45 min to 1 hour per lesion. this includes the excision, margin examination and closure which are all performed the same day in the office. On average it takes about 1.1-1.2 stages per lesion to remove a skin cancer, which means that 90% of the lesions are removed after 1 attempt. On occasion if the patient ahead of you has a positive margin we can get backed up a liitle bit, which is not something we have control over. So, we advise patients to bring something to read and relax. Be prepared to spend the morning or afternoon, so most likely it will be a pleasant surprise that it will be quicker than you thought.
We do up to 2 lesions per day on the same patient. This is because insurance companies reimburse us 100% for the first lesion, 50% for the second and nothing for the third. We don't necessarily agree, but recognize that in healthcare today, physicians don't make a lot of the care decisions any longer. Don't try to do this yourself to your local plumber: paying him 100% to fix the first leak and only 50% for the second leak, he probably not be very accepting.