How to choose a MOHS surgeon

This article is written on the basis of many years of experience as a physician, with a varied career that has included working as a senior physician in an academic hospital, teaching medical students and physicians, a physician in the public service, community, and private practice. The purpose of the article is to help those who have discovered that they or a relative has a cancerous growth on the skin of the face, head or neck to choose how to treat it and who will accompany them, guide and treat them.
One would think that this is a trivial matter, simple and clear, and such that there is no need to say too many words about, let alone write an article. However, many years of experience and getting to know the patients and their family members on the one hand and the community of caregivers on the other hand, opened my eyes and proved to me that many, many of those in need of medical treatment do so in an incorrect and dangerous way. A way that may cause them serious damage, health damage, sometimes life-threatening, and often significant financial damage.
The MOHS method is a method that was developed and adapted to the treatment of cancerous tumors of the skin in order to remove cancerous tumors as accurately and completely as possible. According to the guidelines of the Israeli health basket, it is included in the basket treatments for cancerous tumors in the face, head and neck areas.
The issue of choosing a Mohs surgeon is not special or unusual from choosing therapists in other fields, so it can be concluded from the rules I will detail in this article also regarding other fields of medicine. But at the same time, choosing a MOHS surgeon has a number of unique considerations that should be taken into account.
Unlike other methods of tumor resection, in Mohs surgery, the removed tissue is examined for pathological examination under the microscope, during the course of the operation and by the surgeon himself. The examination is a complete examination of the surgical margins and with its help the surgeon directs the continuation of the operation in order to succeed and remove the tumor in its entirety. This unique and special surgical technique means that the success rate in complete removal of the tumors is the highest by a significant margin compared to all other treatment methods. Additional great advantages of this method are minimal damage to the healthy tissues around the tumor, optimal surgical scar and minimal functional and aesthetic damage as a result of the surgery. This surgery has been recognized worldwide as the preferred surgical method for removing skin tumors in the facial areas and other critical areas.
According to principles that have received international validity and were acknowledged in a position paper of the Israeli Dermatologists Association and which are based on the principles outlined in the USA - the birthplace of the method, MOHS surgery is only surgery performed according to the principles of MOHS surgery and one in which the surgeon is also the one who performs the histopathological examination of the tissue surgically removed by himself.
Contrary to popular perception, MOHS surgeries were and are first and foremost a specialty of dermato-surgeons (skin surgeons) whose basic specialization includes thorough training in skin pathology and skin surgery, to which further training and a unique specialization in MOHS surgeries are added. The surgery is also performed by plastic surgeons who have undergone a dedicated specialization in the MOHS method with additional thorough training in the pathology of the skin.
Further training and specialization in MOHS surgeries is carried out by a method of apprenticeship and active learning by expert doctors who wish to specialize in the field. The internship requires a significant period of work with a specialist MOHS surgeon whose main field of activity is MOHS surgeries. To reach a reasonable basic training level, a MOHS surgeon must perform hundreds of surgeries with his own hands under the supervision of a senior MOHS surgeon. Even after the completion of the internship period, the young MOHS surgeon is still not a ripe MOHS surgeon able to deal with all types of tumors and an additional period of active work and gaining experience in the field while learning and extracting lessons from each case is required.
A good MOHS surgeon should be a neat, thorough, patient person with full integrity and determination, since for a MOHS operation to be successful, every extension and possible residual tumor must be reached. It is therefore necessary to adhere to the principles of the method, not to cut corners and not rush to finish the operation. At the end of MOHS surgery, the surgeon must be convinced that he has removed the entire tumor if that is at all possible. In any case of doubt as to the complete removal of the tumor, the surgeon must decide and guide the patient if an additional, wider excision of the tumor bed (=the area of the skin where the tumor developed) is necessary or whether a workup for finding possible metastatic spread and/or additional treatments such as radiation or chemotherapeutic treatments or biological treatments are required.
Israel health ministry does not recognize a formal specialization in MOHS surgery, but there are MOHS surgeons who have undergone thorough formal training both in Israel and in the USA and Europe.
The consequences of a MOHS operation or a "MOHS-like" operation performed by someone who has not undergone appropriate training and was not performed while adhering to the principles of the MOHS method are first of all the danger that the tumor will return, deeper, larger, or in the form of metastases when it is more harmful and more dangerous - and depending on the type of tumor and its location are even life-threatening. Less severe but no less significant consequences for most patients are significant functional impairment, ugly scars, deformity of the face or the operated organ, pain and continuous suffering.
That is the background necessary to understand the importance of making an informed choice when choosing a surgeon who uses the MOHS method.

Unfortunately, many patients who are diagnosed with cancerous tumors on the skin of the face or in other significant locations, do not understand the meaning and consequences of choosing a treating doctor/surgeon casually or from considerations whose importance should be secondary when coming to make such an important decision. Often the decision and choice of a treating physician is made with less attention and effort than those invested in choosing a new baking oven or refrigerator for the home.

If so, how to choose the right doctor to perform the surgery?

• It is important to ask the referring doctor why he is referring to a certain doctor, what his experience with the doctor is, and whether there are other, more recommended doctors, for example those who do not operate through the referring HMO. 
• It is useful to gather information about the doctor on the Internet and social networks. You should look for mentions related to him, references from patients and any information that will help you get to know him and learn about his training, his experience and his conduct. 
• You should try and ask friends who have undergone similar treatments or who know those who have undergone similar treatments about the doctor and also ask other doctors about the doctor designated to perform the treatment. 
• It is important to meet the doctor himself and not a deligate on his behalf, a preliminary meeting before the operation. 
• It is necessary to find out what training the doctor received in surgery using the MOHS method, how many years he has been performing the surgery and how many surgeries he has performed. 
• The doctor should be asked for a full explanation about the tumor, the consequences of its location, the way the surgery is performed, the expected course of recovery and its evaluation if additional treatments or inquiries are required. 
• It is important to make sure that the communication with the doctor is good, open and transparent and that the doctor instills confidence and tranquility. 
• It is important to understand that the patient has no obligation to continue surgery or any treatment with a doctor he does not feel safe and comfortable with and convinced of his skills. 
• It is worth remembering that the wrong choice of a doctor who does not meet the needs can cause great sadness and often also heavy expenses to repair damages, unnecessary additional treatments, repeated surgeries and many more problems. 
• Financial considerations such as the cost of the surgery are also not negligible considerations, but the total cost must be taken into account, including the consequences of a wrong choice and not save a little money when the cost of the surgery and the additional treatments that may be required may be many times more expensive and the small savings may turn into a big loss. 

I hope this article will help as many patients as possible to make an informed choice and I wish a speedy recovery and a return to complete health and success to all who need medical treatments.