Will a Mohs surgeon usually remove other lesions besides the one biopsied prior to the surgery appointment if it is obvious to him with a high degree of certainty that they are basal cell lesions? Also, are subtle, slightly dark red, raw spots on the outer surface of the lower lip that don't heal over several months likely basal cell or squamous cell carcinoma or none?
Removing Multiple Lesions Besides the One Biopsied?
Doctor Answers 4
Mohs surgery after biopsy confirmation
Mohs surgery is performed after a lesion has been biopsied and it's histopathology confirmed. The surgeon should know precisely the nature of the tumor before attempting to remove it with Mohs surgery.
The lip lesions you describe should be evaluated by a dermatologist but sound like actinic keratoses.
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Mohs surgery and biopsies
A Mohs surgeon would need to confirm, despite a clinically-obvious appearance, that a lesion is a skin cancer by performing a biopsy, prior to commencing with Mohs surgery. If a patient is referred to the Mohs surgeon by a dermatologist, then usually the dermatologist biopsies the lesion prior to the referral. If a Mohs surgeon sees a suspicious lesion, it is appropriate for the Mohs surgeon to discuss this with the referring doctor and a plan would be made as to who would biopsy the lesion.
Raw lesions deserve a biopsy on the lip to rule out a skin cancer but there are erosive skin conditions, such as lichen planus, that can cause chronic raw lesions. Some skin cancer acts more aggressively on the lip, especially squamous cell carcinoma, so you should definitely see a dermatologist.
Removing lesions before Mohs surgery
A Mohs College trained Mohs surgeon is also a trained dermatologist and if seen in an appointment prior to the surgery date, will likely be able to look at the other lesions that seem to be concerning the patient and decide on removal vs biopsy vs other treatment. The lesions on your lip sound like precancerous spots called actinic keratoses- but should also be properly evaluated for diagnosis and treatment.
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Does Mohs surgery need a biopsy before surgery?
In general, Mohs surgery is performed after a biopsy has confirmed that the suspicious area is something amenable to treatment with Mohs surgery. After all if we're lucky on the first stage of Mohs surgery you won't see anymore skin cancer. So it is preferable to have pathology documenting that there was a skin cancer there to begin with. If you have nonhealing erosions on your lip, your doctor should evaluate the area to make sure it's not actinic keratosis or squamous cell carcinoma.
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