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 Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas. Mohs Surgery is indicated when:
The Mohs Micrographic Surgery procedure relies on a specific sequence of surgery and pathological investigation:
The best method for reconstructing the surgical wound is determined after the cancer has been completely removed and the extent of the surgical defect has been determined. The primary considerations are preservation of function and maximizing the aesthetic outcome. Small wounds may be allowed to heal on their own, or the wound may be closed with stitches. Facial wounds often require reconstruction with a skin flap, or sometimes a skin graft. Reconstructing a wound with a skin flap involves utilizing lax skin that is adjacent to the wound, whereas a skin graft is performed by removing skin from another area of the body. The benefits and risks of each option will be discussed with you at the time of your surgery.
Mohs Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas. Mohs Surgery is indicated when: