Is It Typical to Need Mohs Surgery on Your Shoulder?

Question

I just had a squamoush cell removed on my shoulder they are now telling me to have mohs surgery. I do not have insurance and Im a cash patient what might be the cost approx. of this treatment

Andrew Kaufman, MD · Answer

There are many reasons that a skin cancer might be treated by Mohs surgery. The most common indications include location (e.g. eyelids, lips, nose, ears), aggressive types of skin cancer, poorly defined clinical margins, involvement of the surgical margins, large skin cancers (e.g. > 1 cm on the face or > 2cm on the trunk and extremities), perineural invovlement (i.e. tumor wrapped around the nerve). Since they're recommending Mohs after the skin cancer was excised (according to your question), I'm assuming the surgical margins could be involved, but the best option is to ask the doctor specifically why he or she is recommending Mohs surgery for your skin cancer. There could be other reasons as well. Regarding cost, that is something that you would have to discuss with the surgeon. Costs might vary. Best bet, in my opinion, is to see a member of the American College of Mohs Surgery. These individuals have completed an additional fellowship in Mohs sugery after their residencies. Good luck.

Laurie Jacobson, MD · Answer

The benefits of Mohs surgery include a lower rate of recurrence of the tumor (ie, the chances of the cancer ever coming back are lower with Mohs than any other procedure) and a more targeted removal of the tumor (only cancerous tissue is removed, sparing healthy tissue). 

	Mohs is recommended for the shoulder if the size is greater than 2.0cm, if you have any immune suppression, if the tumor is more aggressive than usual, or if you are young (under 40 years of age), for example.  Seeing a fellowship trained Mohs surgeon (a member of the American College of Mohs Surgery) is advised. 

	I hope it goes well for you.

Robert Strimling, MD · Answer

Yes, Mohs Surgery offers the highest cure rate for non-melanoma skin cancer, such as squamous cell.  Because squamous cell cancer can metastasize (i.e. spread to distant body sites) and result in death and inadvertent incomplete removal by less accurate methods increases this risk, the most successful treatment method, Mohs Surgery is often the best option, especially when treating an aggressive and/or large skin cancer.  

	Cost depends upon various factors; but, I would expect your cost plus repair to be about $1000-2500, but may be more or less.

Brent Spencer, MD · Answer

Mohs surgery is typically reserved for the areas of the head, the neck, the hands, and genitalia .  There are a few appropriate situations where it may be done on the trunk or extremities.   In these situations, the tumor can be of a large size (>2 cm in diameter), or the tumor can exhibit aggressive histology (poorly differentiated squamous cell carcinoma or an infiltrative basal cell carcinoma are a couple of examples). 

	If you have a fairly small, well to moderately differentiated SCC, then I would probably say that Mohs is not indicated and a simple excision would suffice.  Be very careful, as there are several doctors out there who use Mohs inappropriately.  There is a fairly well-defined criteria where it should be used.

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

Mohs surgery is usually reserved for areas where we try to preserve as much skin as possible. Typically on areas like the trunk, arms, legs, you can take a wider excision because it's easier to close and there is more skin to give. On areas like the face, hands, genitals, ears, etc. we need to make the smallest excisions possible and preserve as much skin as possible, so we only excise small areas level by level, widening and deepening only in needed areas, as are read during slides prepped during the Mohs procedure.

	With all of that being said, if you have had this SCC removed more than once, or if it is extremely large, then a Mohs procedure might be necessary. For specifics on why your physician is recommending this, you need to ask him/her why the procedure is needed.

	The procedure might cost you between $1000-$2000, depending on the number of slides made, the number of levels done during the procedure, and the type of closure done.

Is It Typical to Need Mohs Surgery on Your Shoulder?

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