Mohs Surgery

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, initially developed by Dr. Frederic E. Mohs in 1930’s seems simple: the surgeon removes the cancer, carefully checks to be sure the he or she got it all, then repairs the wound. American College of Mohs Surgery members, however, train in and practice the complex nuances of this process for years so they are prepared to handle any situation they may encounter. The following diagram describes the steps they follow for each Mohs surgical procedure.

Step 1

The Mohs Step-by-Step Process: Step 1

The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur. A surgery starts with the American College of Mohs Surgery (ACMS) specialist examining the visible lesion and planning what tissue to remove. The patient then receives local anesthesia, and the Mohs surgery begins.

Step 2

The Mohs Step-by-Step Process: Step 2

The surgeon removes the visible portion of the tumor using careful surgical techniques.

Step 3

The Mohs Step-by-Step Process: Step 3

The ACMS surgeon next removes a deeper layer of skin and divides it into sections. With the help of technicians, the surgeon then color-codes each of these sections with dyes and makes reference marks on the skin to show the source of the sections. A map of the surgical site is then drawn to track exactly where each small portion of tissue originated.

Step 4

The Mohs Step-by-Step Process: Step 4

In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer.

Step 5

The Mohs Step-by-Step Process: Step 5

If the surgeon finds cancer cells under the microscope, he or she marks their location on the “map” and returns to the patient to remove another deeper layer of skin — but only from precisely where the cancer cells originated. This method ensures that the Mohs surgery results in the smallest scar possible.

Step 6

The removal process stops when there is no longer any evidence of cancer in the surgical site. Because Mohs surgey removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.

At this point, the surgeon discusses reconstruction options, should they be required, and then post-operative care. Mohs surgery recovery tends to be easily manageable because of the use of local anesthesia and the careful surgical techniques.

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.