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Mohs Micrographic Surgery Skin Cancer Treatment North Valley Dermatology 14155 N. 83rd Ave., Suite 110 Peoria, AZ 85381 (623) 215-0911 Meet Deborah Zell, MD Dr. Zell graduated with her B.S. from Tulane University with the honors of Summa Cum Laude and Phi Beta Kappa while earning double majors in Mathematics and Chemistry. She then attended the Tulane University School of Medicine and subsequently completed an Internal Medicine internship in New Orleans, LA at Tulane Medical Center. Dr. Zell then conducted numerous clinical research trials at the University of Miami in the Department of Dermatology, focusing primarily on scarring. After that, she completed her dermatology residency at the University of Miami, where she cared for a diverse and international patient population, and was the recipient of several prestigious awards in surgery and research. Dr. Zell completed a highly sought after Mohs Micrographic Surgery Fellowship in New York, where she performed surgery at the State University of New York – Downstate, the V.A. Hospital in Brooklyn, and in private practice on Long Island. She has also practiced dermatologic surgery in private practice in New York City. Throughout her career, Dr. Zell has also authored numerous dermatologic articles and textbook chapters. Dr. Zell is highly trained and skilled in the surgical treatment of skin cancer. In her practice, she serves as dermatologic surgeon, pathologist and reconstructive surgeon. Her goal is to provide the highest level of treatment, service, and patient care. For more information, please call to schedule a consultation with Dr. Zell or visit our website for a brief video on the Mohs procedure at: www.northvalleydermatology.com North Valley Dermatology 14155 N. 83rd Ave. Suite 110 Peoria, AZ 85381 623.215.0911 Deborah Zell, MD FAAD Board Certified Fellowship Trained American College of Mohs Surgery Medical Director Mohs Surgery WHAT IS MOHS MICROGRAPHIC SURGERY? Mohs is a specialized surgery to remove skin cancer while minimizing the removal of normal tissue. It is named after the originator of this technique, Dr. Frederick Mohs, who created this procedure at the University of Wisconsin in the early 1940s. Mohs allows for a scar that is as small as possible, and minimizes the chance for significant disfigurement. After each layer of the tumor is removed, the sample is examined under a microscope by Dr. Zell. She then knows exactly where to take the next layer, and can determine when the entire tumor has been removed. After your cancer is removed, Dr. Zell will discuss your options to promote optimal healing. Possibilities include allowing the wound to heal by itself, repairing with sutures, or reconstructing the wound with a surgical flap or skin graft. WILL MOHS SURGERY CURE ME? Mohs surgery provides the highest cure rate for skin cancer when compared to all other treatment options. If you have a basal cell cancer, there is a 99% chance that you will be cured with Mohs surgery. If you have a squamous cell cancer, there is a 95-97% chance that you will be cured with Mohs surgery. Mohs is also very effective in curing skin cancers that have recurred after prior treatment by other methods. It is important to note that follow-up visits with your referring physician are important to detect a rare recurrence. After your postoperative period, you will return to your referring physician for routine skin care and tumor surveillance. WHERE IS MOHS SURGERY PERFORMED? Mohs surgery is performed during a single visit in an office setting using local anesthesia to numb the affected area. You do not need to be put to sleep or treated in a hospital. THE OPERATION WHAT IS MOHS SURGERY USED TO TREAT? Step 1 The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur. Step 2 The visible tumor is surgically removed. Step 3 A layer of skin is removed and divided into sections. The surgeon then color codes each of these sections with dyes and makes reference marks on the skin to show the source of these sections. A map of the surgical site is then drawn. Step 4 The undersurface and edges of each section are microscopically examined for evidence of remaining cancer. Step 5 If cancer cells are found under the microscope, the surgeon marks their location onto the “map” and returns to the patient to remove another layer of skin - but only from precisely where the cancer cells remain. Step 6 The removal process stops when there is no longer any evidence of cancer remaining in the surgical site. Because Mohs surgey removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact. © 2008 - All Rights Reserved\American College of Mohs Surgery Mohs surgery is used to treat basal cell skin cancer, squamous cell skin cancer, and select melanomas. It is an excellent choice for treating larger tumors, recurrent tumors, tumors in sensitive areas and areas of cosmetic and functional importance such as the eyelid, nose, ear, face, neck, hands, feet and genitalia. Mohs surgery spares the maximum amount of normal tissue, and therefore allows for the best cosmetic and functional result. WHAT WILL HAPPEN ON THE SURGERY DAY? HOW SHOULD I PREPARE FOR THE DAY? The typical surgery day begins in the morning and can last from 3-8 hours. The duration of your surgery depends upon how extensive your tumor is, and the number of layers that need to be obtained to remove your entire tumor. Prior to surgery, eat a normal breakfast, and take your regular medications unless otherwise instructed by your doctor. We have comfortable accommodations at North Valley Dermatology which include a TV, free wi-fi, select refreshments, and space for you and a guest should you decide to bring one for all or part of the day. We do encourage you to bring food and reading materials for your comfort. WHAT HAPPENS AFTER MY SURGERY? Most people have very little discomfort after the procedure, and are able to return to normal activity the day after surgery. We do recommend no exercise or heavy work for at least 48 hours after surgery to minimize bleeding. We will instruct you on managing your dressing changes, and will provide recommendations for optimal postoperative care.