Seattle Mohs - Sam Naficy, MD - Mohs Reconstructive Surgery in Bellevue & Seattle



 
Naficy Plastic Surgery & Rejuvenation Center
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Mohs Seattle

Mohs is a technique for removal of skin cancers. The name Mohs comes from the name of the physician, Dr. Frederick Mohs, who developed the skin cancer removal technique decades ago. The Mohs technique is also known as Mohs micrographic surgery, Mohs excision, Mohs removal, or simply Mohs surgery. Mohs is typically performed for basal cell carcinoma and squamous cell carcinoma of the face. Mohs may occasionally be performed for melanoma of the face.

What is Mohs?

Simply stated, the Mohs technique is a method of removing skin cancers that confirms complete removal of the skin cancer by examining all of the margins of the removed tissue under the microscope. The Mohs specialist thus serves the role of both removing the skin cancer and making the pathology diagnosis of whether all the cancer has been removed.

Who Performs Mohs?

The Mohs procedure has two critical components:

  • Mohs Removal of the skin cancer
  • Mohs Reconstruction of the defect

The Mohs removal is performed by a specially trained group of dermatologists known as Mohs specialists. Mohs reconstruction of the skin cancer defect can either be performed by a plastic & reconstructive surgeon or by the Mohs specialist, depending on patient preference and on the location and complexity of the defect.

Mohs Removal

The Mohs procedure starts by numbing the skin cancer and surrounding skin by injections of local anesthesia. The skin cancer is removed in one piece and the underside of the removed tissue is mapped (divided into regions). The tissue segments are then frozen and thinly sliced, placed on glass slides, and stained for examination under the microscope. The Mohs specialist then examines the removed skin cancer tissue checking to see if there is any skin cancer present at the edge of the removed tissue. This processing and examination of the tissue is performed in an expeditious manner, typically over an hour, during which time the patient is still in Mohs specialists' office.

If skin cancer is found at the edge of the removed tissue, then more tissue is removed from the wound and the entire process (called a Mohs stage) is repeated until all margins are found to be clear of skin cancer. At this point the patient is ready for reconstruction (repair) of the Mohs defect.


Mohs Technique

Mohs Technique





First stage removes most of the skin cancer but a small portion is left behind





Another layer of tissue is obtained from the wound and examination under the microscope reveals that there is still skin cancer left behind in one of the four quadrants (left image). Therefore a second stage is performed to complete removal of the skin cancer (right image)

Mohs Reconstruction

Dr. Sam Naficy specializes in aesthetic reconstruction of facial defects after Mohs surgery. The majority of Mohs defects are on the face and many of those are on the nose and lip areas where skillful reconstructive surgery is required to avoid a significant cosmetic deformity. Mohs defects can range in size from 6 mm (size of a pencil eraser head) to over 10 cm (four inches) in size. The majority of Mohs defects are repaired in an outpatient setting under IV sedation. Depending on the size, location, and complexity of the Mohs defect, additional reconstructive procedures may be required to produce the best cosmetic result.

Nose Reconstruction

Reconstruction of the nose is one of the most challenging aspects of plastic surgery. The nose is a three dimensional structure made up of not only skin, but also muscle, cartilage, and bone. Aside form its cosmetic importance; the nose serves a vital function in breathing, smell, and taste. Dr. Naficy has been performing complex nasal reconstruction procedures for nearly 15 years and has written a textbook on nasal reconstruction after Mohs. Click here to view more photos of nose reconstruction performed by Dr. Naficy.


Before nasal reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma
Before

After nasal reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma
After
Nasal reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma

Lip Reconstruction

Lips are also common sites for occurrence of skin cancers. Basal cell cancers typically occur on the upper lip whereas squamous cell cancers occur on the lower lip. Lips serve a vital role in cosmetic beauty of the face and are an important functional structure for speech, chewing, and swallowing. Click here to view more photos of lip reconstruction performed by Dr. Naficy.


Before lip reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma
Before

After lip reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma
After
Lip reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma

Cheek Reconstruction

Cheeks are also common sites for occurrence of skin cancers and in particular for certain types of melanomas such as lentigo maligna. Cheek defects often encroach on the skin of the lower eyelids and one of the biggest reconstructive challenges in cheek reconstruction is to avoid distorting the lower eyelid. Click here to view more photos of cheek reconstruction performed by Dr. Naficy.


Before cheek reconstruction by Sam Naficy, MD following removal of a lentigo maligna melanoma
Before

After cheek reconstruction by Sam Naficy, MD following removal of a lentigo maligna melanoma
After
Cheek reconstruction by Sam Naficy, MD following removal of a lentigo maligna melanoma

Forehead & Temple Reconstruction

Reconstruction of defects involving the forehead and temple area can be quite challenging since this region has fairly stiff skin with not a great deal of laxity. Also one needs to take measures to avoid distortion of the eyebrow, which can at times occur if the skin cancer defect is in proximity to the brow region. Click here to view more photos of forehead and temple reconstruction performed by Dr. Naficy.


Before forehead reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma
Before

After forehead reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma
After
Forehead reconstruction by Sam Naficy, MD following removal of a basal cell carcinoma

Mohs Advantages

The main advantages of the Mohs technique are the following:

  • Mohs allows for examination of all margins for residual cancer and thus has the highest cure rate
  • Mohs allows for maximal tissue preservation, meaning that no more skin is removed than necessary
  • Mohs is typically performed under local anesthesia and no IV sedation or general anesthesia is required

Mohs Disadvantages

The main disadvantages of the Mohs technique are the following:

  • Mohs is a lengthy procedure, often requiring hours to complete
  • Often times, for scheduling reasons, the plastic surgery reconstruction of the Mohs defect needs to be performed on a different day
  • Mohs is typically performed under local anesthesia and no IV sedation is available.

Scheduling Mohs

If you have a facial skin cancer and are interested in scheduling the Mohs procedure you may contact us to initiate the scheduling process. We can help set up the Mohs procedure for you as well schedule you with Dr. Naficy to perform the reconstruction of your Mohs defect.

Dr. Naficy works in tandem with a number of fellowship trained Mohs specialists in the Seattle and Bellevue area. Dr. Naficy's nursing staff will schedule your Mohs procedure at a convenient time and location. The reconstruction of the Mohs defect by Dr. Naficy is typically performed on the day following the Mohs removal but may at times be scheduled on the same day, typically later in the afternoon.

Seattle Mohs Specialists


Dr. Daniel Berg
Nordstrom Medical Tower
1229 Madison Street, Suite 1090
Seattle, WA 98104

Dr. Craig Birkby
Nordstrom Medical Tower
1229 Madison Street, Suite 1090
Seattle, WA 98104

Dr. Linda Chang
Nordstrom Medical Tower
1229 Madison Street, Suite 1480
Seattle, WA, 98104

Dr. Darryl Fader
Swedish Ballard Campus
1801 NW Market Street, Suite #107
Seattle, WA 98107

Dr. Annalisa Gorman
Nordstrom Medical Tower
1229 Madison Street, Suite 1480
Seattle, WA, 98104

Dr. Laurie Jacobson
Meridian Medical/Dental Pavilion
11011 Meridian Avenue N., Suite 102
Seattle, WA 98133

Dr. Peter Odland
Nordstrom Medical Tower
1229 Madison Street, Suite 1480
Seattle, WA, 98104

Dr. Jennifer Reichl
Meridian Medical/Dental Pavilion
11011 Meridian Avenue N., Suite 102
Seattle, WA 98133

Dr. Heather Rogers
Madison Skin & Laser Center
1101 Madison,Suite 1490
Seattle, WA 98104

 

Eastside Mohs Specialists


Linda Chang, MD
1551 116th NE
Bellevue, WA, 98004

Dr. Darryl Fader
Overlake Medical Tower
1135 116th Ave. NE, Suite 350
Bellevue, WA 98004

Annalisa Gorman, MD
1551 116th NE
Bellevue, WA, 98004

Dr. Nobuyoshi Kageyama
North Pacific Dermatology
1200 112th Ave NE. Suite C-187
Bellevue, WA 98004

Peter Odland, MD
1551 116th NE
Bellevue, WA, 98004

 

Mill Creek/Everett Mohs Specialists


Dr. Dieter Schmidt
North Sound Dermatology
15906 Mill Creek Blvd, Suite 105
Mill Creek, WA 98012

 

Edmonds Mohs Specialists


Dr. Laurie Jacobson
21727 76th Ave W, Suite H
Edmonds, WA 98026

 

Preparing for Mohs

For optimal healing after Mohs surgery and facial reconstructive surgery please take note of the following principles:

  • Quit smoking since smoking impairs healing after reconstructive surgery and can result in poor wound healing and scarring
  • Avoid medication and supplements that thin the blood (mainly Aspirin and Ibuprofen). See the full list of medications to avoid
  • Take your prescribed antibiotics as instructed
  • Avoid excessive lifting and physical activity after your reconstructive procedure
  • Follow your post-operative instructions and ask if not sure about how to take care of your wound
  • Keep your follow-up appointments with Dr. Naficy

Feel free to contact us if you have any other questions about the Mohs procedure, your Mohs reconstruction, or your skin cancer treatment.


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Naficy Plastic Surgery & Rejuvenation Center     1110 112th Ave NE Suite 150 Bellevue, WA 98004     (425) 450-0880
 


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