Mohs surgery is a highly advanced treatment for skin cancer requiring extensive fellowship training beyond dermatology residency. In this technique, the physician serves as oncologic surgeon, pathologist, and reconstructive surgeon. During this procedure, the visible skin cancer is removed and processed in the Mohs laboratory, where it is then examined under the microscope by the Mohs surgeon. As opposed to other ways of examining tissue under the microscope, the Mohs technique allows us to visualize 100% of the surgical margin microscopically, resulting in highly accurate detection and mapping of the skin cancer.
After examining the tissue under the microscope, the Mohs surgeon draws a map to show where the residual skin cancer remains. Using this map, subsequent layers of cancer-containing tissue can then be removed while sparing the normal tissue. This process is repeated until the entire skin cancer, including any roots, is completely removed. In this way, as much normal skin is preserved as possible during the complete removal of the skin cancer.
While there are many physicians who perform Mohs surgery, only individuals who have undergone highly specialized fellowship training in Mohs and reconstructive surgery have the best skill and experience necessary to perform your surgery. The fellowship program is approved by the American College of Mohs Surgery (www.mohscollege.org)
Remember, the Mohs surgeon serves three functions: 1) oncologic surgeon, removing the cancer in critical anatomic areas 2.) pathologist, in viewing the microscopic tissue samples to determine whether the specimen is cancer-free; and 3) reconstructive surgeon. Only after a mentored fellowship can one gain adequate experience to perform this technique competently. Make sure to ask your Mohs surgeon if he or she is “fellowship-trained” specifically in Mohs surgery.
Mohs Surgery is most appropriate for skin cancers that are:
- Located on cosmetically or functionally critical areas requiring tissue sparing, especially the head and neck, hands, feet, and genitals.
- Recurrent and/or have failed previous standard surgical treatment
- Clinically ill-defined or infiltrating, aggressive, large, or rapidly growing
Benefits of Mohs Surgery
This tissue-sparing technique of Mohs Surgery offers several advantages over other treatments. It allows for potentially smaller scars because it minimizes the removal of normal skin. It results in the highest cure rate of any treatments for skin cancer – up to 99% for basal cell carcinoma and squamous cell carcinoma. It is performed under local anesthesia as an outpatient, office-based procedure without the risks and side effects of general anesthesia. Once it is proven microscopically that the tumor has been completely removed, most wounds are then sutured and repaired through one of a variety of reconstructive techniques.
Mohs Surgery Prep
Mohs Surgery Patient Education Video
Please click the link below to the American College of Mohs Surgery website for more information regarding skin cancer and the details of Mohs Surgery.