Any experience with MOHS surgery?

[BonnieA]

I had basel cell cancer on my nose. Went to an ENT MD and he took it off at the hospital, it was the most painful experience when he put in the local anesthetic. Cancer came back, same place, two years later. This time I went to a MOHS MD. Hardly felt it, what a change, and my nose looks just fine. This time it hasn't returned after 8 years.

 

[torinsmom]

I had BCC on the tip of my nose and had Mohs done. They had to re-scrape 5 times and I was left with a decent sized hole. My insurance paid for a plastic surgeon to close it up. The nose has very little skin to deal with, so it was a decent procedure to get it closed without a graft. I still have a light scar but no disfigurement.

 

[Pembo]

The surgeon that did my Mohs is also certified in plastics.

 

[GotLabradors]

I had MOHS done in my nostril 2 years ago. The dermatologist did the MOHS in his office. Because of where the cancer was, it couldn't just be stitched shut. A plastic surgeon had to do a skin graft the next morning at an out patient facility. Most people don't notice my scars unless I mention them.

 

[torinsmom]

The surgeon that did my Mohs is also certified in plastics.

Mine was a really complicated procedure so they sent me to a specialized plastic surgeon--it's all he does. I didn't want a graft from behind my ear, so he cut skin on one side of my nose to cover the hole on the other side. Then he cut skin on the bridge to cover the place left skinless by that. Then he sewed up the area on the bridge. All the skin was left connected to nerves and blood vessels so there was no chance of rejection. My face looked like Frankenstein for about a week, but it left a very thin scar that is barely noticeable.

 

[Ladygoldenhair]

What does one look for to know you should see a doctor? A pimple, discoloration, new freckle?

 

[roliepolieoliefan]

What does one look for to know you should see a doctor? A pimple, discoloration, new freckle?

Something that has changed in color or shape or won't heal.

 

[GotLabradors]

What does one look for to know you should see a doctor? A pimple, discoloration, new freckle?

I had a spot that would ooze, crust over, & scab. Rinse and repeat for several months. It turned out to be squamous cell skin cancer. I get a check once a year now.

 

[LukenDC]

What does one look for to know you should see a doctor? A pimple, discoloration, new freckle?

I had a flesh colored bump on my face that would easily bleed. Just washing my face or toweling off was enough to make it bleed.

 

[asta]

What does one look for to know you should see a doctor? A pimple, discoloration, new freckle?

I had a spot on my arm that was not very big. It stayed red or pink but the real clue that something was wrong was that it turned into a small, scaley sore whenever it was exposed to any sun at all. I knew that the rest of my skin had never reacted that way.

 

[Pembo]

Mine looked like a pimple. It appeared one day on my neck and never left.

 

[minkydog]

I had a flesh colored bump on my face that would easily bleed. Just washing my face or toweling off was enough to make it bleed.

That's the way one of mine was. I'd wake up with blood on my pillow. One day, it opened up in a business meeting and there I was, my nose pouring blood! So, off to the dermatologist I went. I figured it was a little basal cell cancer, but I didn't realize I had TWO on that nostril. The second one didn't look like anything more than just a tiny fold of flesh. When they told me that it was also positive, you could have knocked me over with a feather.

Thankfully, Basal Cell cancers are very easy to treat. Nearly all of them can be completely eradicated with minor surgery. They never need chemo or radiation. And if you don't remove them, they don't generally change into anything else--they just get broader and uglier. Of course, it's hard for a lay person to tell the difference in a normal skin lesion and an abnormal one. And most people can't determine if they have basal cell, squamous cell(more invasive), or melanoma (very invasive and deadly.) So, it's always a good idea to have your spots checked out by someone more knowledgeable than you. People with light skin, hair and eyes are more prone to skin cancers, but people with dark skin, hair and eyes can also develop skin cancers. Most dermatologists recommend a full-body mole check once a year, especially if you had several sunburns as a child or you were a sun-worshiper at any time of your life.

 

[IDoDis]

I'm reviving this thread instead of starting a new one. About 2 1/2 weeks ago I was diagnosed with basal skin carcinoma on my forehead. I think the spot had been there for over a year and was not very noticeable or discolored. Just a bump under my skin. I noticed it had gotten slightly larger right after the holidays. I tried microdermabraision to take off the outer layers of skin in hopes that that was the problem and it would heal, but that didn't work. I made an appointment with a dermatologist in January and I was seen earlier this month.

I am having a Mohs procedure done in a little over 2 weeks. I hope I don't look like Frankenstein when all is said and done. The area is larger than the size of a pencil eraser right now. The area is still not completely healed from the biopsy. It's still really read in that spot.

My question is this - Did the doctor's office code this as a surgery or just an office visit? I have a co-pay for a specialist office visit, but if this is considered surgery, then I have a huge deductible and have to pay 10% of the cost, as well. I realize all insurance companies are different and many have changed (like mine did) on January 1st of this year, but if you have a deductible with an out of pocket max to pay with a percentage before the insurance pays 100%, how were you billed for this? I called our health insurance company and asked, but they had no idea. I called the doctor's office and the person who does the billing is on vacation.

 

[Simba's Mom]

I'm reviving this thread instead of starting a new one. About 2 1/2 weeks ago I was diagnosed with basal skin carcinoma on my forehead. I think the spot had been there for over a year and was not very noticeable or discolored. Just a bump under my skin. I noticed it had gotten slightly larger right after the holidays. I tried microdermabraision to take off the outer layers of skin in hopes that that was the problem and it would heal, but that didn't work. I made an appointment with a dermatologist in January and I was seen earlier this month.

I am having a Mohs procedure done in a little over 2 weeks. I hope I don't look like Frankenstein when all is said and done. The area is larger than the size of a pencil eraser right now. The area is still not completely healed from the biopsy. It's still really read in that spot.

My question is this - Did the doctor's office code this as a surgery or just an office visit? I have a co-pay for a specialist office visit, but if this is considered surgery, then I have a huge deductible and have to pay 10% of the cost, as well. I realize all insurance companies are different and many have changed (like mine did) on January 1st of this year, but if you have a deductible with an out of pocket max to pay with a percentage before the insurance pays 100%, how were you billed for this? I called our health insurance company and asked, but they had no idea. I called the doctor's office and the person who does the billing is on vacation.

Gee, that's an interesting question and one we'll find out the answer to soon! DH ended up having an (unrelated) melanoma and he ended up going to MD Anderson cancer treatment ctr in Houston. As far as the basal cell carcinoma, they pretty much said what Ive read here-it really doesn't cause problems and the melanoma was so much more a priority, so he's been dealing with the surgery, lymph node biopsy, etc. for that. However, back to the issue of MOHS surgery-when he went back for the post-surgical Melanoma check-out, and told them he was ready for basal cell carcinoma treatment and which did he think they should do, the surgeon said "Well, if it were me, I wouldn't have the basal cell carcinoma treated any other way but MOHS." That's all he needed to hear to make a decision! So he'll have MD Anderson do it, only because there's no place else much closer and as they said, he's already been treated there. I kind of hope it is an office co-pay.

 

[IDoDis]

Gee, that's an interesting question and one we'll find out the answer to soon! DH ended up having an (unrelated) melanoma and he ended up going to MD Anderson cancer treatment ctr in Houston. As far as the basal cell carcinoma, they pretty much said what Ive read here-it really doesn't cause problems and the melanoma was so much more a priority, so he's been dealing with the surgery, lymph node biopsy, etc. for that. However, back to the issue of MOHS surgery-when he went back for the post-surgical Melanoma check-out, and told them he was ready for basal cell carcinoma treatment and which did he think they should do, the surgeon said "Well, if it were me, I wouldn't have the basal cell carcinoma treated any other way but MOHS." That's all he needed to hear to make a decision! So he'll have MD Anderson do it, only because there's no place else much closer and as they said, he's already been treated there. I kind of hope it is an office co-pay.

Thanks for your info. I hope it's considered an office visit since it's called a "procedure." It would be a $40 copayment. If it's billed as outpatient surgery, then we could be on the hook for $2250.00.

 

[roliepolieoliefan]

I'm reviving this thread instead of starting a new one. About 2 1/2 weeks ago I was diagnosed with basal skin carcinoma on my forehead. I think the spot had been there for over a year and was not very noticeable or discolored. Just a bump under my skin. I noticed it had gotten slightly larger right after the holidays. I tried microdermabraision to take off the outer layers of skin in hopes that that was the problem and it would heal, but that didn't work. I made an appointment with a dermatologist in January and I was seen earlier this month.

I am having a Mohs procedure done in a little over 2 weeks. I hope I don't look like Frankenstein when all is said and done. The area is larger than the size of a pencil eraser right now. The area is still not completely healed from the biopsy. It's still really read in that spot.

My question is this - Did the doctor's office code this as a surgery or just an office visit? I have a co-pay for a specialist office visit, but if this is considered surgery, then I have a huge deductible and have to pay 10% of the cost, as well. I realize all insurance companies are different and many have changed (like mine did) on January 1st of this year, but if you have a deductible with an out of pocket max to pay with a percentage before the insurance pays 100%, how were you billed for this? I called our health insurance company and asked, but they had no idea. I called the doctor's office and the person who does the billing is on vacation.

Do you if the doctors office is licensed as a surgery center?
When I worked for a Moh's surgeon , he had one room approved to be billed as a procedure performed in a surgery center.
He tried to do the more difficult procedures in there because he could bill the insurance more.

If he did a procedure in another room other than the "approved" room , he could only bill for an office procedure.

 

[LukenDC]

For purposes of co-payment, my MOHS procedure was considered an office visit and not a surgery. I have Kaiser Permanente, so other insurance carriers may be different.

 

[Aussie66]

General Comments
While the Original Poster has possibly had their question answered, I want to share my experience of Moh's so that people are reassured about this surgery. First of all, I want to stress that Moh's currently is the surgery with the highest rate of success with approximately 98-99% cure if caught early and the one that will give you the most peace of mind as the results are provided on the day of the surgery, and the surgeon won't stop until she/he gets it all. However, the kind of cancer I had has a high incidence of death if not caught early, so I was extremely worried because I had a lot of delay before I was able to be treated. In my experience, doctors also don't tell you much about the option of Moh's, often referring patients to their circle of close friends/colleagues. You have to research this stuff yourself. This surgery also has the best cosmetic results.

Diagnosis and delays in Treatment over Covid
After much delay, I was diagnosed with a intradermal squamous cell carcinoma with follicular involvement. My cancer was in the area between the lip and the nose. This is a very dangerous area for squamous cell carcinoma, as it can spread if left untreated through hair follicles and glands through to other parts of the body such as the brain. It was a small pearly lump, sore to the touch at first when it came up early December, 2019. I was tempted to squeeze it as I thought it was a pimple, but fortunately, I did not. I live in a regional part of Australia and couldn't get into a surgery over Christmas because of Covid restrictions, and also Christmas holidays. So, I was forced to wait until February until a doctor came up from Sydney to do his consultations and book biopsies. Finally in early February, I had the consultation, but had to wait until mid-February to have the biopsy, and again was forced to wait two weeks until the doctor returned to get the result. The doctor who did the biopsy refused to cut out the cancer, and wanted to refer me to a plastic surgeon. There were further waits and delays because the plastic surgeon was not visiting the area because of Covid. I did find a doctor in Brisbane - 7 hours drive away or an hour flight - who agreed to do the surgery, but who cancelled it just as I was boarding the plane due to his nurse having Covid. I went to Brisbane anyway, and did as much research as I could on the best surgery, spoke to lots of doctor's receptions, and finally settled on Moh's surgery, as - given the delay of 3 months wait - I was really concerned that this cancer had spread and that I was destined to die. I flew back home, and down again in mid-March for the Moh's surgery.

The surgery
A wonderful female doctor in Brisbane performed the surgery, explaining everything as she went. She first marked off the area with a pen, then injected two lots of long-lasting local anesthetic. It feels like your lip and the area above it is swollen and about to burst, but there is no pain. She explained that 50% of surgeries require only one pass. She incised the area, that whole part taking 15 minutes, and then sent me back to the waiting room with a gauge covering to await the microscopic results. I was called back in about 40 minutes. Good news! The margins were clear, and she then began cauterizing the wound (yes, you do smell your own flesh burning), and stitching me up. She placed 4 internal stitches in, and one long stitch covering about 7 loops. The nurse bandaged the wound, and told me not to get it wet for at least 2 days. I was sent home with 7-days of antibiotics and instructions on how to care for the wound: covering it for 12 weeks with a light skin coloured micropore tape after the first couple of days. I flew home and had the stitches removed at my local surgery. The original doctor who did the biopsy was there, and commented on how the surgeon had done a 'very good job' and that I should expect a great result in terms of scaring etc.

The recovery
Immediately after the surgery my lip was still swollen and numb for most of the day. I could not eat or drink hot food, and it was hard to open my mouth until the second day. I practised lowering my jaw a lot. By the afternoon of the second day, I could just comfortably eat a burger before flying home. I was sore for the first few days and took paracetamol 4-hourly while awake. This greatly helped the pain and swelling. When the stitches came out 7 days later (I always leave stitches in two days longer than recommended as the wound always opens up otherwise), the wound was barely noticeable. I carefully wiped the wound with sterile water and applied the micropore tape after every shower. It's 2 weeks post-surgery now, and the skin coloured micropore tape matches my skin perfectly, and no one notices the surgery.

Recommendation
I totally recommend this surgery to anyone with BCC or SCC's especially on the lip area. I feel so relieved to know all my cancer is gone, and I can expect no further problems from that particular one. The doctor also recommended laser photo-therapy PDT, which is a new treatment, most effective on the face. A cream is placed on the skin and the face exposed to a blue laser/light which destroys precancerous cells. It can be done 4 weeks after surgery for Moh's. It has a week down time as the face is red for a week later, similar to a peel.

I wish everyone the very best in their treatments. Please consider Moh's! My husband died at age 47 from colon cancer. My sister died at 39 from Thyroid and lung metastasis. Don't take any chances. Do everything you can to get the best treatment in the first instance.

 

[longboard55]

I have had 4 Mohs, 2 ears, neck and forehead. No scars at all, the non mohs removals have huge scars