Dr Ally-Khan B. Somani Discusses Advantages & Challenges of Mohs Surgery

Mohs surgery is extremely effective and cost-saving, but it is more difficult when patients have let the tumor grow too large or have had a previous unsuccessful surgery, explained Ally-Khan B. Somani, MD, PhD, director of Dermatologic Surgery and Cutaneous Oncology at the Indiana University School of Medicine.

Transcript (slightly modified)

What are some of the challenges a surgeon performing Mohs surgery may encounter?

As a Mohs surgeon at an academic center, we see a lot of patients who … have ignored care because of insurance issues that they have. They’ve let tumors grow beyond normal size, making it much more difficult to clear the tumors, larger defects, larger sizes. So that’s one thing that always, I scratch my head about, thinking that you know what, you could’ve removed this tumor when it was smaller in size, than letting it grow to 4, 5, 6 times the size when they come in. So again, more morbidity associated with larger defect.

The other challenge is also our reimbursement, so Mohs is one of the specialties that we are actually a one-stop shop. So most people don’t realize it, but with Mohs surgery we are looking at 100% of the edge and the bottom of what we remove, so cure rates are theoretically 100%; we say it’s 99%. So we offer a smaller hole, a higher cure rate, which gives us the confidence to rebuild this. And we do it all under local, so patients can be older, patients can have it done all in one day. So actually from a cost perspective, actually it’s very cost-saving.

Unfortunately, one of the challenges of Mohs surgery that I find is that I see patients referred to me after they’ve seen a plastic surgeon or an ENT, where they’ve had big, disfiguring surgery sometimes done and the tumor comes back, because the roots have been left behind, which makes it a challenge.

How have advances in technology helped to improve surgery techniques?

If you look at the history of Mohs surgery, it started as chemosurgery where the issue was, or the process involved, fixing tissue on the patient and they’d come back the next day, we would remove it and leave them with a hole that would heal in. Mohs has evolved to the point where most Mohs surgeons that are trained by the American College of Mohs Surgery, they’ve done a fellowship, and that allows them the ability to not do it all on the same day with HNE but also they’re trained in reconstructive surgery. So most Mohs surgeons after fellowships are able to reconstruct with plastic reconstructive techniques, and allow those patients to have superior scars as well, and it’s again done under local.