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Should the Surgeon Also Be the Pathologist for MOHS Surgery?

asked 2 years ago by marcia72q in Florida
Latest answer by Andrew Kaufman, MD
Question viewed 1,769 times
Tags: skin

I was just diagnozed with BCC and MOHS Surgery has been recommended. I am a self pay patient and the Dematologist stated that there will be a separate fee for the pathologist who has to be onsite. Is this normal or should I insist on a Surgeon who also acts as the pathologist? What kind of fees are usually associated with this procedure?

10 answers to Should the Surgeon Also Be the Pathologist for MOHS Surgery?

+1

Need for Pathologist for Mohs Surgery?

By definition Mohs surgery requires one individual to work as both surgeon and pathologist; if either of those roles is delegated to another doctor, by definition it is not Mohs surgery. If you are looking for a Mohs surgeon, I would recommend that you see a member of the American College of Mohs Surgery (ACMS). To be a member of the ACMS an individual has to complete an accredited fellowship in Mohs surgery, which includeds additional advanced training in Mohs surgery, reconstructive... more
Andrew Kaufman, MD

Los Angeles Dermatologic Surgeon

www.dermatology-center.com

+2

Moh's vs. frozen section

With modern frozen section techniques examining the edges of the specimen, the two techniques are very similar. They are both performed by fine physicians. However, I prefer to have a board certified pathologist review all pathologic specimens rather than a dermatopathologist, a dermatoligist who has trained in Moh's surgery. There are enough borderline lesions that are difficult to interpret; I prefer to have a pathologist who lives and breathes pathology rather than a dermatologist who... more
Brent Moelleken, MD

Beverly Hills Plastic Surgeon
+1

The Mohs Surgeon is the Pathologist

Mohs surgery by definition and to be billed as such is required to have the removal and the pathology performed  by one single and same surgeon. Anything else is not Mohs surgery. The billing is not separate for the pathology it is all bundled into the removal and examination under the microscope. You do not get a separate bill from a pathologist. My suggestion is that if you desire the advantages of Mohs surgery including a 99% cure rate then you seek out a fellowship-trained Mohs... more
Shawn Allen, MD

Boulder Dermatologist
+1

Mohs surgeon is both the pathologist and the surgeon, by definition

By the definition, Mohs surgeon is both the pathologist reading the frozen sections prepared by Mohs technician as well as the surgeon perform the excision. Mohs micrographic surgery is the standard of care for non-melanoma skin cancers on the face and neck. The insurance reimbursement bundles both pathology and surgical services. If your 'mohs surgeon' needs a pathologist onsite, you should look for another experienced Mohs surgeon.
William Ting, MD

Bay Area Dermatologic Surgeon
+1

Mohs surgery implies that the physician will act as both the surgeon and the pathologist

Hi Marcia72Q, Mohs surgery is a technique in which the dermatologist surgically removes the skin cancer and then reads the pathology. There is one fee which covers both components of this procedure. There will likely be the need for a surgical reconstruction or repair of the defect created from surgical removal of the tumor and that is typically not included in the fee for Mohs surgery. I would strongly recommend finding a fellowship trained Mohs surgeon to treat your BCC as mohs surgery... more
Ritu Saini, MD

New York Dermatologic Surgeon
+1

The Mohs Surgeon is the pathologist and the surgeon

By it's very definition, "Mohs surgery" implies that the surgeon (dermatologist) is the same one cutting as is acting as the pathologist to interpret the frozen section margins. If you are told that you are having "Mohs surgery" yet there is a separate pathologist from the surgeon interpreting the frozen sections, then most likely you are not being treated with Mohs surgery. In that scenario, you are having "frozen sections" performed by a pathologist that... more
Steven Hacker, MD

West Palm Beach Dermatologic Surgeon

www.palmbeachdermasurgery.com

+1

Surgeon and pathologist for Mohs Surgery

Dr. Krant hit the nail right on the head. Mohs Surgeons examine 100% of the tissue margin. Standard frozen section techniques typically examine less than 1%. Peer reviewed studies have shown time and time again that the cure rate with Mohs Surgery for non-melanoma skin cancer is greater than any other technique.
Jerome Potozkin, MD

Walnut Creek Dermatologic Surgeon
+1

Mohs surgery surgeon IS the pathologist

As most of the above answers state, Mohs micrographic surgery for skin cancer means by DEFINITION, the Mohs surgeon is also the pathologist reading slides for THAT particular skin cancer surgery case. The reason for this is that the surgeon knows best the orientation and location of the tissue, and the quality of the surrounding skin on the patient, for the best "clinicopathologic" correlation of what is under the microscope, to what is going on with the patient. A properly,... more
Jessica J. Krant, MD, MPH

Manhattan Dermatologic Surgeon
+1

Mohs surgery

Dear Marcia72q, In order to be a Mohs surgeon, by definition, the surgeon must act as both the physician and the pathologist. There is one fee that covers both services. A Mohs surgeon does not have a separate fee for the pathologist. If this is the case, you are not going to a Mohs surgeon. You can find one who is fellowship-trained (a must) and approved by the Mohs College at the Mohs College website. You can search by the area in which you live. In order to be a approved by the Mohs... more
Kavita Mariwalla, MD

New Haven Dermatologic Surgeon
+1

Mohs surgery

By definition, with Mohs surgery, the same treating physician functions as both the surgeon and pathologist. There should be a single charge for the entire removal of the skin cancer (including tumor excision and pathology). There would probably be a separate charge for repair of the defect following Mohs surgery. I hope this makes sense. Good luck.
Bryan K. Chen, MD

San Diego Dermatologist

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