Mohs Surgery
What Is Mohs Surgery?
Mohs micrographic surgery, which is performed in our office using local anesthesia, is a state-of-the-art treatment for skin cancer in which the physician serves as a surgeon, pathologist, and reconstructive surgeon. It yields the highest cure rate of all skin cancer treatments, with cure rates approaching 99% for tumors that have not previously been treated. The procedure relies on the precision and accuracy of examining tissue under a microscope to trace and ensure removal of the skin cancer, which may have roots that extend beyond what is visible to the naked eye. In addition, the removal of healthy skin is minimized, resulting in the smallest possible surgical defect and thereby decreasing the potential for scarring.
Mohs micrographic surgery was developed by Frederic E. Mohs, M.D. in 1936 at the University of Wisconsin. In its original form, described as “chemosurgery”, the technique utilized a 20% zinc chloride fixative paste that was applied directly to the skin of the patient for fixation of the tissue. Subsequently, the involved skin was surgically removed by serial excision with microscopic control of the tissue margins.
Removal of tissue was performed in layers and color coded with dyes in order to orient specimens to the patient. Dr. Mohs created a unique technique of color-coding excised specimens and developed a mapping process to accurately identify the location of remaining cancerous cells. This original “chemosurgery” technique, which is no longer performed, was very painful and sometimes took days to complete.
The surgical procedure has been extensively refined over the last seven decades, but it still relies on the fundamental principles of color-coded mapping of excised specimens and their thorough microscopic examination. Surgeons now excise the tumor in layers and examine the fresh tissue immediately. This reduces the normal treatment time to one visit and allows for immediate reconstruction of the wound.
In 1967, the American College of Mohs Micrographic Surgery and Cutaneous Oncology was formed to recognize surgeons who have completed specific, certified training in the Mohs technique. The College also functions as a regulatory and certification body for over 60 Mohs fellowship training programs and provides a source of continuing education for more than 700 practitioners of Mohs Micrographic Surgery.
Mohs Surgery Information
Mohs Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas. Mohs Surgery is indicated when:
- The borders of the cancer are poorly defined
- The cancer is large
- The cancer has recurred after a prior treatment
- The cancer has previously been incompletely removed
- The cancer is in an area where preservation of healthy tissue is paramount to achieve the best possible cosmetic and functional reconstructive outcome, such as the nose, ears, eyelids and lips
- The cancer has grown rapidly
- The cancer has aggressive microscopic features, such as morpheic, infiltrating, or micronodular
- The cancer tracks along nerves (perineural invasion)
Surgery FAQs
The length of time required to complete a Mohs surgery case is variable, and is based on the involvement of the tumor and the complexity of the surgical reconstruction. As a general rule, each stage of Mohs will require approximately one hour for tissue processing to be completed. If the tumor persists at the margins, an additional stage will be performed, which will add an additional hour to the procedure. Additional stages, if necessary, are performed until all of the cancer has been removed. The surgical reconstruction will then take an hour or more to complete. Given the highly variable time requirements to complete the Mohs procedure, we ask that all patients anticipate being in the office all day and plan their schedules accordingly. Much of the day involves waiting in the office’s reception area or the examination room while the tissue samples are being processed.
Available at the following clinics:
Mohs Surgery Providers
