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Mohs Micrographic Surgery Overview

While there are many surgical and nonsurgical approaches to treatment of skin cancer, Mohs Micrographic Surgery is the most effective treatment for skin cancer.
The procedure was initially developed by Dr. Frederic E. Mohs in 1930’s. The technique is based on saucer shaped removal of the skin cancer with a very thin rim of healthy looking tissue. A “map” of the removed tissue is made and the sample is then sent to an on-site laboratory. Once prepared, slides are examined by the surgeon for the presence of the remaining tumor. If tumor found, it is mapped and the surgeon then removes additional layer of tissue precisely in the area of the tumor. The process is repeated until all tumor had been successfully removed. The precision of the surgery allows for most complete tumor removal possible while sacrificing as little normal tissue as possible. Thus, it minimizes the chance of re-growth and lessens the potential for scarring or disfigurement.
The procedure is usually performed by a dermatologist who has completed at least one additional year of fellowship training under the tutelage of a Mohs College member.  Because a single physician is extensively trained in surgery, pathology, and reconstruction, Mohs surgery has the highest success rate of all treatments for skin cancer. Clinical studies conducted at various national and international medical institutions demonstrate that Mohs surgery provides five-year cure rates exceeding 99 percent for new cancers, and 95 percent for recurrent cancers.  The Mohs technique is also the treatment of choice for cancers of the face and other sensitive areas as it relies on the accuracy of a microscopic surgical procedure to trace the edges of the cancer and ensure complete removal of all tumors down to the roots during the initial surgery.

Click here for the high resolution MOHS patient video and here for the low resoution version.

Why Does My Skin Cancer Need Mohs Surgery?

Because Mohs Surgery spares healthy tissue and offers the highest rate of cure, it is especially appropriate when:

  • the cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, fingers, toes, genitals;
  • the cancer was treated previously and recurred;
  • scar tissue exists in the area of the cancer;
  • the cancer is large;
  • the edges of the cancer cannot be clearly defined;
  • the cancer is growing rapidly or uncontrollably;
  • high cure rate is desirable

About Mohs Micrographic Surgery: The Procedure and Post-Operative Care

The Mohs Micrographic Surgery Process
Mohs surgery is usually an outpatient procedure performed under local anesthesia. The patient remains awake during the surgery. Most of the surgeries are began and completed on the same day. The procedure starts early in the morning and continues until all tumor is removed. Duration of the process depends on the extent of the tumor and the amount or reconstruction necessary.

Mohs Surgery Reconstruction- Repairing the Wound

In most cases, wounds are reconstructed on the same day as the Mohs surgery. Reconstruction options include:

  • a small, simple wound may be allowed to heal on its own.
  • a slightly larger wound may be closed with stitches.
  • larger wounds may require a skin graft or a flap.
  • if the tumor is very large, another surgeon with special skills may be called upon to assist with reconstruction.

Mohs Micrographic Surgery Post-Surgical Management

Post-surgical check-ups are recommended in order to monitor the patient’s progress and spot any possible cancer recurrence in a timely manner.
Since two of five patients with one skin cancer will develop another within five years, follow up is extremely important for early detection of any new lesions.

About Mohs Micrographic Surgery: Cost Effectiveness

As the incidence of skin cancer soars, greater focus is currently being placed on the cost effectiveness of treatment. Over the past decade, studies have been conducted to calculate and compare the costs of Mohs Micrographic Surgery with those of traditional surgical methods.Studies cited in Journal Watch Dermatology1 show that Mohs surgery is no more costly than standard excision and less expensive than radiation therapy or excision in an ambulatory surgery center. Because the process of Mohs Surgery minimizes the risk of recurrence, it reduces and frequently eliminates the costs of larger, more serious surgery for recurrent skin cancers.