Arizona Mohs SurgeryAnir Dhir MD, FACMS

Arizona Mohs Surgery is committed to providing the safest environment for both patients and staff. For decades, surgical facilities have been at the forefront of fastidious infection control practices due to challenges such as Hepatitis and HIV. To combat newer airborne diseases such as Covid-19 (SARS-CoV-2), we employ Global Plasma Solution’s NPBI air purification technology. This state-of-the-art system is utilized by prestigious medical institutions such as the Mayo Clinic, as well as Google, Harvard University, and the White House. Pathogen reduction testing results may be viewed here. Our six procedure rooms eliminate the typical “recovery room” utilized by many Mohs practices, where patients are placed in a communal setting while waiting on slides to be processed by the lab.

Mohs surgery is generally reserved for skin cancers occurring in more cosmetically and functionally critical areas such as the face, ears, scalp, neck, hands, feet, and shins. Larger and more aggressive cancers in non-facial locations, as well as “recurrent’ tumors (those that have failed other therapies) are also appropriate candidates for Mohs surgery. Mohs surgery is also the best approach for skin cancers that are poorly defined, arise in a scar, grow rapidly, or occur in a patient with a compromised immune system. Mohs surgery is generally not needed for thin, small cancers in non-critical locations because these can be successfully managed with simpler techniques.

Dr. Dhir was the single busiest Mohs surgeon in Kentucky for many years prior to opening Arizona Mohs Surgery. He has performed over 37,000 Mohs procedures with a cure rate greater than 99.5% and an infection rate of only 0.2%. He is a nationally recognized expert in both Mohs surgery and facial reconstruction.

In Mohs surgery, one physician functions as both surgeon and pathologist. If a physician removes a skin cancer and sends the specimen to another lab or pathologist for analysis, he or she is not performing Mohs surgery for two reasons:

1. a single physician is not correlating the clinical and microscopic pictures for maximum accuracy, and
2. only a small portion of the margins is examined instead of 100% of the true 3-D circumferential margin as with Mohs surgery.

Most patients spend 2 to 4 hours with us. Much of that is “downtime” where you rest comfortably while waiting on our team to prepare frozen Mohs sections and read the slides to ensure clear surgical margins. We encourage patients to bring reading materials to pass the time, and we also provide Wi-Fi access so that you may watch a movie or surf the internet on your own laptop computer, phone, or iPad. Please note that surgeries for larger, neglected, aggressive, recurrent, or mid-facial cancers may take longer, particularly if multiple stages are needed to clear the tumor and/or more advanced reconstruction is needed.

The majority of wound closures are performed in our office. Occasionally, we may need to utilize an outside surgical specialist to perform the post-Mohs reconstruction if the tumor turns out to be larger, deeper, or more complex than initially anticipated. If an outside surgical specialist is needed, the reconstruction may take place on the same day or on subsequent days. Please note that it is safe to delay the reconstruction, and that it’s possible that hospitalization may be needed for extensive reconstructions.

The majority of Mohs surgeons and dermatopathologists believe that permanent (formalin-fixed) tissue sections allow more accurate margin analysis for melanoma than Mohs frozen sections, even if additional MART-1 immunostaining is done. This is not an issue for basal and squamous cell carcinomas, where frozen sections are universally accepted and allow more efficient, same day analysis. Therefore, we follow current NCCN surgical margin guidelines which state "the gold standard for histologic assessment of excised melanoma is use of permanent sections". Our specimens are evaluated within 24 - 48 hours by a board-certified dermatopathologist. NCCN guidelines also suggest that the surgeon consider delaying closure of melanoma excisions until margin analysis has been completed if a flap or graft may be required. This means that some melanoma surgeries may require 2 or more visits to ensure maximum accuracy.