Why Does my Mohs Procedure Take 3 Weeks ? Or More?

I was diagnosed with cellular dermatofibroma (1.5cm) on my right shoulder and had it surgically removed. After pathological testing it appeared it wasn't removed completely. A 2nd attempt proved the same result. Now doctors are suggesting an adjusted Mohs procedure, in 3 stages with 1 week in between, leaving an open wound during that time. They say they need 1 week for testing because the staining takes a lot of time. Is this normal, because I am reading everywhere Mohs is a same day procedure

Doctor Answers 3

Immunohistochemical stains take time...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I wouldn't call what you are having "Mohs".   You might call it the slow Mohs variant if they are really doing en face sectioning of the tissue.  More appropriately, I would say that you are having staged excisions where they are doing permanent sections with immunohistochemical stains.  This is not abnormal to do for rare tumors.   The staining and processing take time when it is done this way. 

The same day procedure that you read about for Mohs is when frozen sections are done.  In rare instances, immunohistochemistry is done on frozen sections, but for the most part, permanent sections is where you see this utilized. 

Frisco Dermatologic Surgeon

Mohs Surgery for Skin Cancer: One Day or More?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

By definition Mohs surgery requires that one person act as surgeon and pathologist. If one of these duties is delegated to another person, by definition it is not Mohs surgery. It may be a staged excision or they may be orienting the tissue so that they see the greatest percentage of the peripheral and deep surgical margins, but it should not be described or billed as Mohs surgery.

It may be that in your case this is the best option for treatment of your lesion. They may feel that they need permanent sections or special stains to fully evaluate the tumor and the surgical margins. Best option is to discuss the situation with your doctor. Good luck.

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 16 reviews

Recurrent cancer procedures

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I agree with Dr. Spencer. By definition what you are having done isn't a Mohs procedure, and yes, those are same day procedures. What you are having done is a multi-staged cancer removal. Sometimes when aggressive cancers recur (which yours has done several times now) a regular excision just isn't going to work. So you do what's considered a staged excision with multiple sections removed, sent to a specialized lab, and stained with multiple types of stain. The allows your physician to see which portions of the skin are continuing to have some sort of cancer cells left behind that haven't been able to be removed with the prior excisions. I'd say staged excisions like this are very, very rare, but absolutely necessary in instances like yours.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.