It is an honor to participate in your care. Your health, safety, and comfort are paramount to us.
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.
Yes. A biopsy removes only a small portion of the top of the skin cancer for diagnostic, not therapeutic, purposes. It does not remove the skin cancer roots, which are typically wider and deeper than what appears on the surface. This is the reason why microscopic analysis and precise mapping are the cornerstones of Mohs surgery.
Patients are typically biopsied by their dermatologist, primary care physician, or other surgical subspecialist and then referred to Dr. Dhir specifically for Mohs surgery. Dr. Dhir is a specialist, and your insurance company may require that you secure a referral from your primary care physician before seeing a specialist. Therefore, please check with your insurance plan to determine if a referral is required. It’s also a good idea to check whether your insurance plan requires pre-certification or pre-approval for surgery with us.
Dr. Dhir was the single busiest Mohs surgeon in Kentucky for many years prior to opening Arizona Mohs Surgery. He has performed over 31,000 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:
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.
We numb all of our patients prior to surgery to ensure your comfort. If you are a little anxious, we can also provide a small dose of an oral sedative to help you relax (“minimal sedation”). In that case, you will need to bring a friend or family member who can drive you home and remain with you for the remainder of the day. For larger cases, we also typically prescribe a few oral narcotic tablets to keep you comfortable for the first day or two after surgery when you may be sore.
Yes. Preoperative instructions may be found here.
It is actually safest for patients to continue important blood thinners to minimize the risk of cardiovascular events. Fortunately, the risks of bleeding with Mohs surgery have been proven to be low even with blood thinners. In the event that an outside surgical subspecialist will be performing the post-Mohs reconstruction, we ask that you please follow his or her recommendations regarding whether to stop your blood thinners.
In most cases, the wound is closed following successful excision of the cancer. This generally involves stitches on both the inside and outside of the wound. The stitches may dissolve on their own or require a return visit to our office in 7 to 14 days for removal. In some cases, the wound may be able to heal nicely without stitches. At the completion of surgery, we will provide you with detailed instructions on postoperative wound care depending on your reconstructive approach. A general sense of post-operative instructions can be found here.
Yes. Any surgical treatment, including Mohs surgery, creates a scar. A scar is the body’s natural way of healing after an injury. We will do our absolute best to minimize scarring. The length of the final scar is often greater than patients expect, because skin reconstructions are typically 3 times longer than the surgical defect size to eliminate puckering of the skin that occurs during closure. Your scar will soften and fade for several months after surgery, so please be patient as your body heals. You can greatly reduce the risk of suboptimal scarring by carefully following our pre- and post-operative instructions, especially with regards to avoidance of alcohol and tobacco consumption in the peri-operative period. Meticulous wound care and minimizing strenuous activities are also very important.
After surgery, we ask that you return home and rest for the remainder of the day. Patients can usually shower after 1 to 2 days, but you should avoid swimming in a public pool, lake, or ocean for at least 2-3 weeks. Lighter activities and going for a walk are usually OK after 1 to 2 days, but it is important to limit strenuous physical activities, including golf, exercise, tennis, cycling, and yoga / Pilates, for 2 weeks to allow the wound to develop sufficient strength before being subjected to stretching and tension. This is very important to achieve the best possible cosmetic result which we believe is as important as curing your cancer.
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 for the excision of melanomas. Our specimens are evaluated within 24 hours by a board-certified dermatopathologist. NCCN guidelines suggest that the surgeon consider delaying closure of melanoma excisions until margin analysis has been completed. This means that some melanoma surgeries may require 2 or more visits to ensure maximum accuracy.
Unfortunately, yes. After having one skin cancer, statistics show that you carry a higher chance of developing another skin cancer. Therefore, it’s important to perform monthly self skin examinations and visit your referring physician for routine check-ups at least once each year. You can significantly reduce your future risk by practicing good sun protective measures and avoiding tanning beds and tobacco use. It’s never too late to develop healthier lifestyle practices because the human body has an amazing capacity for healing and regeneration.
Dr. Dhir and Arizona Mohs Surgery participate with Medicare and the majority of private insurance plans in Tucson, including Aetna, BCBS, Humana, and United Healthcare. Health insurance plans and contracts continually change, so we highly recommend that you contact your insurance carrier to ensure that Arizona Mohs Surgery is a contracted provider with your specific plan. We are honored to serve our military men and women in uniform via participation in Tricare. At present, the two main plans with whom we are NOT contracted are AHCCCS and Cigna. If we are not participating providers in your commercial plan, you may still see us an out-of-network provider but this may cause you to incur higher costs depending on your insurance company’s policies. We are unable to accept patients with AHCCCS as their primary insurance carrier. Please refer to our Financial Policy form for details regarding your financial obligations.
You may pay a bill via this website or in person. For your convenience, we accept cash, checks, Visa, MasterCard, American Express, Discover, and Visa Debit cards. We do not participate in Care Credit or offer any financing or payment plans.
You are truly a miracle worker! Thank you so very much for taking such good care of GW. We appreciate all of you so much.
A young lady at the entrance greeted me in such a friendly manner that the expression on her face, her posture, and her words caught my attention. The instructions are also striking: "you may bathe", "please try to stop smoking", "we would prefer", "please perform a few days", "please be patient as you heal." And finally, "We wish you a speedy recovery." These instructions come from doctors and nurses who are authorities in dermatology. Yet, they are delightfully modest.
Thank you for the very professional and personal care you and your staff provided me yesterday. No one looks forward to surgery of any kind. But your manner and clarity of explanations help to set me at ease. Your staff was very warm, very caring, yet very professional. They explained each part of the process, leaving no uncertainties in my mind about what to expect next. It was very assuring as we moved through the procedure.
The care that you and your staff showed me when I had my nose surgery was phenomenal!! I have never been to a doctor's office that showed so much compassion for his patient and your staff was fantastic, too!
I appreciate your generosity in allowing me to observe you at work. This was very educational, and now I feel I can properly inform patients about the expected experience when undergoing Mohs surgery. It is clear to me what an elegant, accurate, and effective method to excising skin cancers. I am impressed with the way your clinic is run. The nurses and staff are very professional and responsive to the patients which I’m sure they appreciate. I hope to see you in the future!
I just wanted to let you know how much your kindness touched my heart. Thank you!
Thank you for the wonderful care you provided for me in the past weeks. I so appreciate you and value your friendship of the many past years. You are truly a great professional who's caring and skills is beyond compare.
Looking back on 2003, my family and I have faced many stressful and trying times traveling back and forth from doctor's office to office. We are very fortunate to have such a caring doctor along with staff who are always willing to help in anyway possible. Thank you and your staff for not giving up and traveling down this long, hard road with me. You have always been straight up and honest with me and had my best interest in mind, not many doctors are like that and take things as personal.
AT is doing fine. I just wanted to thank you for all your kindness. You were super in my eyes. We will never forget you all. God Bless you all.
Just wanted to drop you a note to let you know that I'm very pleased with the outcome and appreciative of your superb skill as a surgeon.