Mohs surgery - on the importance of the examination by the surgeon before the operation

Many patients diagnosed with skin cancer in facial, scalp, and neck areas by a dermatologist, family doctor, plastic surgeon, or another physician are told that they need Mohs surgery. 

They often assume that the next step is to go to the operating room and have the growth removed. 

While this scenario does happen in many cases, there are instances where the patient arrives at the surgical suite, is operated on by a physician they don’t know, and receives no explanation about the surgical procedure they are about to undergo. In my view, this approach risks infringing on the patient’s right to receive optimal medical care.

In many cases where a patient is referred for surgery, the diagnosis is incorrect, or the referral is unjustified. The patient may actually require a different type of treatment (based on my personal experience, this is true in nearly 50% of cases!). Therefore, the surgeon must examine the suspicious lesion, perform a clinical evaluation, and also use dermoscopy. Only if the diagnosis remains unclear and diagnostic biopsy is necessary should a biopsy be performed. It’s important to note that in many cases, a diagnostic biopsy is unnecessary.

Only after the surgeon confirms the diagnosis based on their examination can they determine the most appropriate course of action. Mohs surgery is indeed an extremely precise procedure, considered to have the highest likelihood of completely removing the tumor while preserving aesthetics and organ function. However, it is not suitable for every patient. There may be underlying issues that limit the feasibility of the surgery. Additionally, there are situations where alternative treatments, such as creams, liquid nitrogen, radiation, or other oncological methods, may be more appropriate for managing such lesions. During the consultation, the surgeon explains the surgical details to the patient and answers any questions, ensuring that the patient can provide informed consent regarding the planned procedure.

From the patient’s perspective, the preoperative evaluation provides an opportunity to get to know the surgeon who will perform the procedure, assess their feelings toward the surgeon, and determine whether they trust and believe they will receive optimal care. The patient has the chance to ask the surgeon any questions that concern them and can also conduct further research about the physician, the procedure, and any other questions that arise using the wealth of information available online.

Only after such a preliminary meeting does the patient have a full understanding of what lies ahead, and only then can the surgeon proceed with the planned Mohs procedure with the patient’s informed consent.

This article represents my perspective and stance on preoperative evaluation and is written as a public service.

Wishing everyone success and a full and speedy recovery, 

Dr. Gilead