Arizona Mohs Surgery & Dermatology Anir Dhir MD, FACMS, & Shelby Coplen, PA-C

Of course.  We would be honored to assist you with evaluation and biopsy of suspicious lesions if not already done by your dermatologist or primary care physician.  We are also happy to perform excisions and prescribe non-surgical treatments when Mohs surgery is not needed.

On October 1, 2024, we are delighted to have Shelby Coplen, PA-C, join our experienced team. Shelby has practiced medical dermatology in Tucson since 2017.  She is an expert in skin cancer screenings, non-surgical treatment of skin cancer, and treatment of rashes, psoriasis, rosacea, and acne. 

Mohs surgery is the gold standard 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 some “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 in most locations. 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 is happy to assist patients with cancers qualifying for Mohs surgery, simpler excision, or non-surgical therapies.

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.

Absolutely.  Unlike many physicians performing Mohs surgery in Tucson, Dr. Dhir completed a dedicated and prestigious American College of Mohs Surgery (ACMS) accredited fellowship prior to entering private practice.  He was then the single busiest Mohs surgeon in Kentucky for many years prior to opening Arizona Mohs Surgery. He has performed nearly 42,000 Mohs procedures with a cure rate over 99.5% and an infection rate of only 0.2%.

Dr. Dhir is a nationally recognized expert in both Mohs surgery and facial reconstruction. Since 2003, his colleagues have repeatedly elected him to both Best Doctors in America and Castle Connolly's Top Doctors - recognitions that place Dr. Dhir in the top 4 to 7% of all U.S. board-certified physicians, respectively.

Most patients spend 3 to 5 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.

Mohs Surgery is a very accurate, office-based, outpatient procedure performed entirely under local anesthesia.  It is best suited to small- to medium-sized skin cancers that have not yet invaded into important underlying tissues such as muscle, cartilage, nerves, or bone.  Advanced tumors, those that have failed multiple previous procedures, or those at higher risk of deep invasion or metastasis are often most safely and effectively treated by a hospital-based head and neck surgical oncologist.  These advanced surgical cancer specialists have sophisticated training and expertise in larger surgeries and lymph node biopsies.  They also have access to anesthesiologists and other specialists like Medical Oncology and Radiation Oncology who are often needed for more advanced skin cancers.

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.