Does a board certified Mohs dermatologist have the same skills as a plastic surgeon?

Question

I am scheduled with a Mohs dermatologist in Canada for my reoccurrent BCC on scalp. The lesion was excised in 12-2012-by plastic surgeon-2015-lesion came back same spot. If the closure of the wound is complex-does the dermatologist have as much expertise as the plastic surgeon?

F. True Lansden, MD · Answer

MOHS Dermatologists are dermatologists who have taken an extra year of training in dermatopathology and skin cancer removal using the MOHS technique.  Plastic surgeons are trained to close complex wounds that may require the rearrangement of tissues and the transposition of tissues over some distance.  Dermatologists are not surgeons and even though some are trained to reconstruct some of the defects that they make, they do not get the training or experience with complex wounds that plastic surgeons encounter on a daily basis.

Nancy Kim, MD · Answer

A fellowship trained Mohs surgeon is a dermatologist who has undergone an extra year of training to perform a specialized skin cancer removal technique called Mohs surgery. This is a technique which has the highest cure rate of any skin cancer removal procedure. Mohs surgeons are also trained in reconstructive techniques to make the site as aesthetically pleasing as possible post surgery, many of these techniques are the same techniques employed by plastic surgeons, however, Mohs surgeons are not technically plastic surgeons.

Barbara Jemec, MD, FRCS(Plast) · Answer

Thank you for your question.In the UK a Mohs' surgeon removes lesions suitable for Mohs' and a Plastic Surgeon reconstructs them, unless it is a simple closure.Plastic Surgeons are trained differently and a we has an extensive knowledge of closing simple and complex wounds.A surgeon will always be better at closing a wound and a Plastic Surgeon is trained in all reconstructive options including scar revisions.Recurrence with Mohs' is less than 1%, and it depends on what type of BCC you have whether it is suitable for Mohs' surgery, for instance if it is a nodular and well circumscribed BCC, Mohs' is no necessary, but for infiltrative or micronodular or hard to define BCCs Mohs' is key. Plastic Surgeons take margins recommended by National Guidelines for various skin cancers. These guidelines were in the UK written by Dermatologists.Operations on the scalp result in a scar where no hair grows, the closure can be optimised to ensure this scar is as small or thin as possible with a variety of options.Plastic Surgeons and Mohs' surgeons each have our strengths and weaknesses and in the UK the collaboration instead of competition between us are there to give the patient the best result.In the end you should go with the doctor who will treat you and their colleagues with respect, has the necessary knowledge to remove the lesion appropriately to get rid of it and the doctor, who treats you and their colleagues with respect and has the necessary knowledge to close the wound appropriately to close the wound. If that is one person, fantastic.Good luck with the surgery.

Lisa Chipps, MD · Answer

A fellowship-trained Mohs surgeon's expertise is in the complete removal of skin cancer and the best possible cosmetic surgical repair of the wound. We treat these defects on the face, and in other delicate and sensitive areas, every day. We use local anesthesia and have this procedure down to a science. The Mohs technique has the highest cure rate for skin cancers, so the risk of recurrence is minimal.Plastic surgeons do have different training. They spend some time on these small wounds, but much of their training is in very large reconstructions of body parts off of the face, or in reconstructing bony and soft tissue problems under the skin. They do not have the same laboratory process to ensure removal of skin cancer that is used for Mohs, so they have to take larger margins and leave a larger wound and scar.

Omar Ibrahimi, MD, PhD · Answer

Hi. I think the most important thing to appreciate in your situation is that Mohs surgery is the best option to treat your skin cancer. It does not matter what the closure looks like if the cancer has not been removed with clear margins. With that said, in regards to closure of the wound, I close over 99% of my Mohs surgery defects (aka wounds). In fact my patient prefer I do their closures for efficiency and cost-effectiveness and they are highly satisfied with the cosmetic outcomes. The majority of closures involved techniques that your Mohs surgeon and Plastic surgeon would have similar training in. In the United States, the majority of skin cancer reconstructive surgery is done by Mohs surgeons/dermatologists.

F. Victor Rueckl, MD (in memoriam) · Answer

This is a great question. I had a patient once who wanted a plastic surgeon to do the procedure, and guess what, the cancer came back because the plastic surgeon wasn't trained in Mohs to actually remove the entire cancer, so two years later I had to do it again. So seek a Mohs surgeon. Part of the rotation and Mohs practice is to learn excessively complex closures. In reality, many Mohs surgeons probably could have been great plastic surgeons who wanted to do more medical procedures. So yes, part of Mohs training is performing complex and great closures. I close 100% of my Mohs procedures myself. "This answer has been solicited without seeing this patient and cannot 
be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

Does a board certified Mohs dermatologist have the same skills as a plastic surgeon?

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