What is Mohs surgery?*
Mohs surgery, also known as Mohs micrographic surgery, was named after Dr. Frederic Mohs. Dr. Mohs developed the technique at the University of Wisconsin in the 1930’s. Mohs micrographic surgery has since been refined into the most advanced, precise, and effective treatment for an increasing variety of skin cancer types.
During Mohs surgery, the surgeon can see where the cancer stops. This isn’t possible with other types of treatment for skin cancer. This has two important advantages:
1. Mohs has a high cure rate--even if the skin cancer has been previously treated by another method.
2. Mohs allows you to keep as much healthy skin as possible because the surgeon only removes the skin with cancer cells. This is especially important when skin cancer develops in an area with little tissue beneath (e.g., eyelid, ear, or hand).
What to expect during Mohs surgery?
If you have Mohs surgery, you’ll see a doctor who is a trained Mohs surgeon. Most Mohs surgeons are board-certified dermatologists who have completed extensive training in Mohs surgery.
During Mohs surgery, patients remain awake and alert. This means Mohs can safely be performed in a medical office or surgical suite. On the day of the surgery, your surgeon will first examine the area to be treated. You’ll then be prepped for surgery by injection of a local anesthetic. This injection only numbs the area that will be operated on, so you’ll be awake during the surgery.
Once the anesthetic takes effect, the surgery can begin. The surgeon starts by first cutting out the visible skin cancer. Next, the surgeon removes a thin layer of surrounding skin. You are then bandaged so that you can wait comfortably.
While you wait, the Mohs surgeon looks at the removed skin under a microscope. The surgeon is looking for cancer cells. If cancer cells are found, you’ll need another layer of skin removed.
This process of removing a thin layer of skin and looking at it under a microscope continues until the surgeon no longer sees cancer cells (called clear margins).
Once cancer cells are no longer seen, your surgeon will decide whether to treat your wound. Some wounds heal nicely without stitches. Others need stitches. To minimize the scar and help the area heal, some patients require a skin graft or other type of surgery.
If you need wound treatment, your Mohs surgeon may treat the wound that same day. These physicians are trained to remove cancer, read the pathology and to reconstruct the wound left from cancer removal such that the patient receives full services care. This extensive training is impressive, but the most notable fact is that Mohs surgery has a success rate of up to 99% for treating skin cancers!
Who is a candidate for Mohs surgery?
Most Mohs patients have a common type of skin cancer like basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). No matter what type of skin cancer you have, Mohs is only recommended for certain patients. The AAD and ASMS recommends Mohs surgery on skin cancers that:
- Develop on cosmetically sensitive areas (i.e. face)
- Develop on areas that need to retain function (i.e. eyelids)
- Have recurred after previous treatment or are likely to recur
- Are located in scar tissue
- Are large
- Have edges that are ill-defined
- Grow rapidly
- Multiple skin cancers that are very close together
Mohs patients have good results, and your surgeon will remove the least amount of skin needed to treat the cancer.
*The above Mohs surgery information has been provided by the American Academy of Dermatology.