About Your Doctor:
Patrick Sniezek, M.D. is the head physician for the Mohs Surgery and Skin Cancer Center at Colorado Springs Dermatology Clinic, P.C.
Dr. Sniezek grew up in East Tennessee and is a graduate of Harvard University and the University of Tennessee School of Medicine, where he graduated with highest honors and was elected to the AOA Medical Honor Society, recognizing the top 1% of medical students in the country. After completing a surgery internship at the National Naval Medical Center in Bethesda, Maryland, Dr. Sniezek served in the United States Navy as an operational flight surgeon.
He completed his dermatology residency at the University of Iowa and then returned to active duty as a staff dermatologist at the National Naval Medical Center where he received the Staff of the Year Award for excellence in teaching. He also served as an Assistant Professor of Dermatology at the Uniformed Services University of Health Sciences in Bethesda, MD.
Dr. Sniezek then had the privilege of receiving his fellowship training in Mohs Surgery and facial reconstruction in Pittsburgh, PA from John Zitelli, M.D., widely considered the premier Mohs surgeon in the country and David Brodland, M.D., the past president of the American College of Mohs Surgery.
Dr. Sniezek is board certified in Dermatology and is a Diplomate of the American Board of Dermatology. He is also an Associate in the American College of Mohs Surgery, a Fellow in the American Academy of Dermatology and the American Society of Dermatologic Surgery. He has authored numerous articles and has lectured on skin cancer at both local and national meetings. When not working, Dr. Sniezek enjoys spending time with his wife and four children.
VIDEO: Mohs Surgery Overview by Dr. Sniezek
Mohs Surgery and Skin Cancer Center
What Makes It Different from a Regular Excision?
Mohs surgery is a highly precise dermatological procedure used for the removal of skin cancers, particularly the two most common forms, basal cell carcinoma and squamous cell carcinoma. A form of micrographic surgery, Mohs surgery has been credited with bringing cure rates for these cancers up to an incredible 98 percent or higher, far exceeding the success rates of other treatments. Best of all, the surgery excises cancerous cells with minimal impact on healthy tissue, making it significantly more desirable than standard excision.
The reason Mohs surgery is able to save most healthy tissue is the unique method of using detailed mapping techniques and microscopically examining tissue during the surgery instead of performing a biopsy afterwards. Rather than simply estimating how far the cancerous cells might extend, this procedure involves removal of one thin layer of tissue at a time, examining it immediately under a microscope for presence of cancer cells, pinpointing the exact location of the cells and continuing excision in that area.
What Happens During the Procedure?
During the procedure, the visible skin cancer is injected with a numbing agent and then removed, along with a thin layer of skin for microscopic examination. The process is repeated again and again all margins of the final tissue sample are cancer-free, at which time the surgery is completed.
Why is Mohs Surgery Better than Simple Excision?
Mohs surgery is preferred by dermatological surgeons because it is the most effective cure for many skin cancers and also causes minimal impact on healthy tissue. By removing only cancerous cells and knowing precisely where the cancer ends, the patient gets the best therapeutic and cosmetic results. Mohs surgery can even be used on some forms of melanoma and other rarer skin cancers. Generally, Mohs surgery is recommended for skin cancers that have recurred after previous treatment, have a high risk of recurrence, have hard-to-define borders, are larger or aggressive, or are located in areas of cosmetic concern, such as the face, hands, feet or genitals.
What Are the Risks?
Like any surgery, Mohs surgery carries some risks, though in this case they are relatively minimal. Problems can include bleeding from or into the wound, pain or tenderness at the surgical site or infection. Pain can be treated with pain relievers once procedure is complete, while infections can normally be treated with oral antibiotics. Rarer complications can include numbness around the surgical area, itching or shooting pain in the affected area or an enlarged scar, known as a keloid.
How Do I Prepare for the Surgery?
We recommend you bathe and wash your hair the morning of the surgery to minimize the risk of infection at the surgical site. Do not wear make-up, perfume or nail polish. You can have a normal breakfast. When you come in to the office, allow some time to complete a medical history form. It’s also helpful to bring along an up-to-date list of prescription and over-the-counter medications, vitamins and herbal products as well as a record of previous illnesses and surgeries. You will need to get a ride to and from surgery, and it’s helpful to have someone there to sit with you in the waiting room while samples are examined.
What Medications Should I Avoid Prior to Surgery?
You should continue to take any medications prescribed by your physician. However, there are certain over-the-counter medications that need to be stopped several days prior to surgery because they may cause increased bleeding during surgery and prolong bleeding afterwards. Please take note of the medications and how far in advance you will need to stop taking them.
Unless prescribed by your doctor, do not take aspirin, even a baby aspirin, or products contain aspirin for ten days before surgery. Non-steroidal anti-inflammatory products like ibuprofen and naproxen should be stopped five days before surgery, as should any vitamin supplements containing vitamin E, ginger, gingko and garlic. Tylenol can be taken any time prior to surgery. If you are taking warfarin (Coumadin) or Plavix, you can continue with your regular dosing.
Alcoholic beverages should be avoided 48 hours prior to surgery, as they can promote bleeding.
What Happens on the Day of Surgery?
Mohs surgery can be a long procedure, depending on the depth of the cancer cells, so your appointment will be scheduled for early in the day. You will be escorted to the surgical procedure room, where you’ll meet the doctor, and the area around the skin cancer will be numbed with local anesthesia. The visible skin cancer will then be removed along with a thin layer of tissue, which will be immediately mapped, coded and sent to the lab for microscopic examination. This part of the procedure takes 10 to 15 minutes. After having a temporary dressing placed on the wound, you can return to the waiting room. It can take from one-and-a-half to two hours for each sample to be prepared and examined, and the process will be repeated until all cancers are removed. As the procedure progresses, more local anesthesia may be administered as needed.
How Long Will It Take?
Although most cancers are removed in three stages or less, you’ll need to plan to stay for the day and should not make any other commitments. You can be prepared for the wait by bringing along a friend or some reading material, or you can take advantage of our complimentary Wi-Fi access. If you want to bring along lunch or snacks, we have a refrigerator available. The surgery is strictly outpatient and you may return home at the end of the day.
Will There Be a Scar?
As with all surgery, there will be a scar. Fortunately, due to the minimal impact of the Mohs procedure on normal tissue, scaring will be kept to a minimum. The doctor will determine whether the best cosmetic results will be achieved by letting the wound heal on its own, repairing it with stitches or opting for a reconstructing skin graft or flap. In a few cases where surgery has been very complex or extensive, your wound will be temporarily closed and you’ll be referred to another surgeon for reconstructive surgery.
What Can I Expect After the Surgery?
For the most part, there are few post-surgical problems for patients having Mohs surgery, and all of them will be discussed with you prior to your procedure. Any minor post-surgical pain can be treated with Tylenol; if pain is severe, prescription pain pills may be prescribed.
Patients may experience temporary swelling around the surgical site, particularly if it is performed near the eyes. Though rare, infection may occur and is treated with antibiotics. Temporary itching in the area may also occur.
There are some rare post-surgical occurrences, which we will discuss with you before your procedure. In some cases, patients experience temporary or permanent numbness around the surgical area. This is caused by cutting of small nerve endings during surgery and normally resolves with time. Particularly when large tumors are involved, there may be temporary or permanent weakness in the surgical area, caused by severing of a muscle nerve. If we feel this may be a problem in your case, we will discuss it with you before surgery. Though it’s rare to experience loss of muscle function after Mohs surgery, it may occur in a few cases.
What Kind of Follow-Up Can I Expect
About one week after surgery, all patients return for a visit to check on how the area is healing and answer any questions or concerns you may have. If the doctor considers it necessary, you may be scheduled for other appointments as the healing process progresses. Though not essential, you may want to schedule a follow-up visit with your referring health care provider. It is important that you continue to schedule regular visits with your dermatologist to monitor your skin for any new skin cancers.
How Can I Prevent Development of More Skin Cancers?
In general, patients who have had one skin cancer are considered at higher risk for more and will definitely want to take measures to minimize their risk. The best defense against skin cancer is protecting the skin from the sun’s harmful ultraviolet rays. Wear high SPF sunscreen with UVA/UVB protection even when you will only be outside for short periods of time. Avoid sun exposure during the peak hours of ultraviolet ray intensity, generally from 10 am to 4 pm, and wear sunglasses and a wide-brimmed hat.
Get to know your own skin. Keep an eye on any changing lesions, new spots, sores that won’t heal, moles that are changing in appearance or any other areas you think may be of concern. It’s far better to schedule an appointment early, when less drastic measures can be used to treat pre-cancerous areas.
Will My Insurance Cover the Procedure?
The cost of Mohs surgery is usually covered either completely or partially by most insurance plans and by Medicare. Our office will contact your insurance company about a week before your surgery to obtain whatever prior authorizations are necessary. We will then call you to inform you of any copay or deductible amount you will need to bring with you on the day of surgery.
How to Get Answers to Your Questions
If you’d like to consider Mohs surgery as a form of treatment, please contact the Mohs Surgery and Skin Cancer Center by calling (719) 471-1763, x126. We’ll be able to schedule an appointment to talk to our Mohs surgery specialist about your options for treatment.