Slow Mohs is a staged surgical excision used to precisely remove melanoma, melanoma in situ, lentigo maligna, and some severely atypical moles. Similar to classic Mohs micrographic surgery, it removes the skin cancer while trying to save as much normal healthy skin around it. The tissue is processed in the “Mohs” method to let the pathologist examine the entire lateral and deep margins to provide the best cure rate possible and allow the surgeon to “trace” the roots and save normal skin. Unlike classic Mohs, skin cancers like melanoma and other atypical pigmented lesions which are made up of melanocytes (cells that make skin color) have to be sent to an off site lab where they are processed overnight. This is because classic Mohs employs frozen sectioning on basal and squamous cell carcinomas which are not made up of melanocytes and can freeze fast (less than an hour) and are easy to read. The color skin cells, melanocytes, do not freeze well when rushed and therefore are hard to read.
Dr. Litani removes the cancer like in Mohs and makes a classic Mohs map with the same inking process. The tissue is sent out where it is processed and read by 2 of the best dermatopathologists in the country who will mark areas of the map and send it back to Dr. Litani the next day. If any tumor cells are present, Dr. Litani will remove another small sliver of affected skin and the process while be repeated and results are delivered the next day. If the specimen is clear, then Dr. Litani will reconstruct the surgical defect to give you the best scar possible.
If you need slow mohs, please understand that you will have 3 appointments on 3 consecutive days. If more than 2 passes are necessary then Dr. Litani will continue the process over the next days as necessary. Each day, you will go home with a pressure bandage that you should not touch. Dr. Litani will provide you with wound care instructions on the day you receive stitches.