Mohs micrographic surgery has set a new standard in skin cancer treatment. An increasing number of physicians are performing Mohs surgery, which is now widely accepted as the most effective treatment for most types of skin cancer. However, not all Mohs surgeons receive the same level of training as Dr. Paula Vogel. When it comes to your skin cancer treatment, you deserve no less than the best. Dr. Vogel has achieved the highest degree of Mohs surgery qualification by completing an American College of Mohs Surgery approved fellowship. For you, this means peace of mind, knowing that you will receive superior quality and competency, as well as an optimal outcome.
The American College of Mohs Surgery was established by Dr. Frederic Mohs himself, and its fellowship training program is generally acknowledged as the highest level in Mohs surgery training. Through an extensive application and interview process, only the most qualified physicians are selected by ACMS to participate in a fellowship program. Participants must undergo a rigorous 1 to 2 year training program after completing a residency in dermatology. During fellowship training, Dr. Vogel studied and trained under the guidance of veteran Mohs College surgeons who have demonstrated expertise in Mohs surgery. A cornerstone of the ACMS fellowship training program is cultivating experience and judgment in each graduate. Since skin cancer occurs in a diversity of forms, degrees and locations, the program is set up to be thorough and stringent.
Dr. Paula Vogel met the following requirements in completing her ACMS fellowship:
• Participated in a minimum of 500 Mohs surgery cases
• Learned to accurately interpret slides of tissue samples removed during Mohs surgery
• Performed a vast array of reconstructions, ranging from the simplest to the most complex, multi-step repairs
As an ACMS graduate, Dr. Vogel gained an uncommon level of exposure, including everything from challenging tumor locations to rare tumor pathology and complex wound reconstruction. Following fellowship at Emory University, Dr. Vogel continued to work alongside other Mohs surgeons in the military. After 3 years of additional experience, she applied for and was selected to Fellow status in the Mohs College, which is the highest position.
Preparing for your Mohs Surgery
• Be prepared to spend the majority of the day at our office
• If you are working, you will want to plan to take the entire day off of work, and most likely, the day following the procedure as well
• Do not plan on going out of town for at least a week after the surgery
Frequently Asked Questions
Will I be put to sleep for this surgery?
No. The Mohs surgery is done with a local anesthetic only. This means that the area will be numbed so you won’t feel the procedure, but you will be awake while the surgery is done.
I am from out of town. Do I need to spend the night after the surgery in San Antonio?
Generally, we do not require patients to stay the night in the San Antonio area; however, there are some occasions where Dr. Vogel would suggest this for cautionary reasons. We cannot tell you for sure if spending the night would be suggested without seeing you first in a pre-operative consult. If you would like to schedule a pre-operative consult to discuss this type of issue, as well as other concerns you may have with the procedure, please let our office know and we will be happy to schedule one for you. If you prefer to have the consult and procedure the same day, we would suggest you prepare for the possibility of staying the night in San Antonio, just in case, but know you may be released to go back home that day. Some patients will choose to stay one night, regardless, if they feel that they may have concerns that might arise overnight (i.e. excessive bleeding from wound site).
What is the Mohs surgery?
Mohs is a tissue sparing surgery that is used to remove a skin cancer from the body. It is typically used on areas where conservation of healthy tissue is priority, such as the face, nose, ears, and hands. The Mohs procedure is executed by removing the visible tumor from a biopsy proven to be skin cancer. Once removed, the tissue is sent to the lab to be processed. Our lab approximately takes 45 minutes to 1 hour to process each set of tissue. Dr. Vogel will then examine all margins of the tissue to see if any cancer cells remain on the edges. If cancer cells are present on the edge, that tells her those cells still remain on the skin in that location. At this point, Dr. Vogel will take an additional margin of tissue from the area on the body that is showing positive margins. This process continues throughout the day until all margins are clear of cancer cells. Once all margins are clear, Dr. Vogel will close the wound.
Will I have a bad scar?
Scarring is a risk of all surgical procedures; however, we will take extreme care to minimize scarring as much as possible. Dr. Vogel is trained, like a plastic surgeon, in the art of closing a wound while preserving a cosmetically pleasing result. On occasion, when working with delicate areas such as the nose, ears and eyes, we may suggest getting a plastic surgeon involved with the closure, but this is rarely necessary.
I am taking blood thinners. Do I need to stop?
Please inform our office of all medications you are currently taking. In some instances, we may ask you to stop some blood thinners for a period of time prior to the surgery. Please do not stop taking any medications without discussing it with our office or with the prescribing physician’s office first, as this could present a risk to your health.
How long will this surgery take?
There is no way for us to say exactly how long the surgery will take. Every case is different. On average, patients are here for approximately 4-6 hours. To be safe, please plan to spend the whole day with our office, and do not have any other appointments scheduled for that day.
Will I have any restrictions after the Mohs surgery?
After the surgery, most patients have sutures that will remain for anywhere from 1 to 2 weeks. During the time that sutures are in the body, you will want to minimize physical activity. The reason for this is that you run the risk of popping a suture if you strain the body too much. Once sutures are removed, most patients are able to resume normal activity.
To learn more about skin cancer and Mohs micrographic surgery, we recommend the websites for the Skin Cancer Foundation and the American Academy of Dermatology.