Beware - You May Not Get MOHs As Defined in the Medical Textbooks !!! - North Port, FL

I had a 2-3mm Nodular BCC for 6 weeks on my neck. ...

I had a 2-3mm Nodular BCC for 6 weeks on my neck. The biopsy had removed the well defined, small nodule and The Dr. cauterized the biopsy site. After a week when I had not received the results of the pathology report, I called the office- they had received the results 2 days after the biopsy. The office told me Dr Jawitz recommended MOHS tissue sparing surgery & closure the same day. I signed a consent for MOHS . In this surgery, the surgeon allows 1.5 to 2 mm from the biopsy site or lesion into normal appearing skin and removes it. Those thin margins are checked for cancer in the office..a map of tissue is made to keep the Dr. orientated so that only tissue with cancer is removed- normal tissue is spared. If any of the margins have cancer cells, they are removed in thin sections... they are checked for cancer. This continues until margins are clear. [time consuming] Then the defect Is closed.
In my case, this would have meant starting at a 9mm across excision point and checking for cancer.
The Dr. removed a large piece, 17mm, across! There were no further excisions of tissue. In 90 min. I learned from staff my margins were clear. Since I expected the 9mm start [smaller than an M&M]I was shocked to see that the hole in my neck was the size of a penny and would need to be closed by a plastic surgeon. [$4,500]
I assumed that Dr Jawitiz was "fellowship trained" since the "on hold" message at Riverchase Dermatology assures you, you are in good hands with their "fellowship trained MOHs surgeons".
Dr Jawitz office is one of the Riverchase group of 6 in SW FL. He does belong to the American Society for MOHs Surgery, an educational group, where he has not taken their fellowship course.
I insisted in getting the report to see where the cancer was located in the excised tissue. It was hard to get. I learned there was NO CANCER in that penny sized piece of tissue; the biopsy had gotten it all.

plastic surgery after MOHs

The penny sized area which was removed from my neck and was covered with a flap, was pulled down from where you can see the mark in the photo, to an inch below it. Now, 6 weeks later, the 2.5" incision is barely visible except for a thumbtack size blob of tissue at each end- I think this is called a "dog ear".. I hope it gets smaller.
Ryan Jawitz, D.O.

There was no explanation of MOHs surgery from the DR or staff- staff just told me to bring reading material. There was no mention of withholding certain vitamins, meds, that might prolong bleeding time for a certain length of time pre procedure. There was no mention of pre-medicating with an antibiotic pre procedure. [I did as I have to artificial knees] I did not see the Dr after the procedure. I had read everything I could to acquaint myself with the procedure and what to expect. I am a retired RN so had a knowledge base. When I got to the Plastic surgeon's office 3 days later, I learned they had 0 info on why I was coming, just the "face Sheet" and that Dr. Jawitz had sent the patient . They squeezed me in for closure the next day. Closure required a pennant flap and more undermined and excised tissue to close.

1 out of 5 stars Overall rating
1 out of 5 stars Doctor's bedside manner
1 out of 5 stars Answered my questions
1 out of 5 stars After care follow-up
1 out of 5 stars Time spent with me
1 out of 5 stars Phone or email responsiveness
2 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
3 out of 5 stars Wait times
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Comments (4)

I thought that Dr Jawitiz was "fellowship trained" since the "on hold" message at Riverchase Dermatology assures you, you are "in good hands with their fellowship trained MOHs surgeons". His card read his specialty was MOHs surgery. I wrongly assumed he was fellowship trained. He does belong to the American Society for MOHs Surgery, an educational group, where he has NOT taken their fellowship course. When I was scheduled, I was told he would close it the same day... he got upset when I asked for small sutures on my neck for closure. I DID call the office manager to discuss this and received no reasonable explanation- I am still clueless as to why he didn't follow the standard procedure as defined. The mystery to me is why he started with such a large piece of tissue, and why he went so deep; this is not MOHs. Then to learn there were NO cancer cells present in the excised sample- I had to undergo plastic surgery repair because he didn't want to take the time to do MOHs? A sad lesson. I will follow your advice to go to an American College of MOHs surgery in the future. I noticed that ALL his patients were told to come back to the office in 14 days for suture removal- no matter what part of their body the surgery had been done. No wonder I had RR tracks on my incision from 2 previous excision [not MOHs] surgeries he did on me. I insisted in getting the report to see where the cancer was located in the excised tissue. It was hard to get. I learned there was NO CANCER in that penny sized piece of tissue; the biopsy had gotten it all.
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I am sorry to read about your experience. Have you tried discussing this with the office? When it comes to Mohs surgery, it is my opinion that you would be best of with someone that has completed formal 1-2 year fellowship training in Mohs and Reconstructive surgery and is a member of the American COLLEGE of Mohs surgery. This will let you feel rest assured that you had someone look at your slides that has done several hundreds of cases with supervision to make sure they are reading the slides properly. Also, most the the time, the area can be sown up by the same doctor on the same day, thus not only optimizing the cosmetic outcome but also making the procedure cost efficient as well. The American College of Mohs surgery has a nice website that provides a lot of educational information.
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I feel bad for you, did you get any explanation why so much was taken?
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No, I didn't. I was shocked. I do think the Dr was upset with me when I ask he do the closure with small stitches- That I didn't want the area on my neck to look like the area where he had removed a small BCC on my leg with a wide incision & 2 layers of stiches. This healed with railroad track marks across an uneven incision. Dr Jawitz said the area was just fine. and was upset with me saying, "nurses are the worst." I pointed out I had had MOHs before on my nose with a flap rotated down from between my eyebrows to cover the large defect. The surgeon used small stiches. It healed well.
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