Mohs surgery is a specialized method of skin cancer excision using a tissue-sparing technique developed in the 1930s by Dr. Frederic E. Mohs that allows intraoperative assessment of 100% of the peripheral and deep tumor margins prior to wound closure. The cure rate with Mohs surgery approaches 99% in most cases.
Typically, Mohs surgery is performed as an outpatient procedure in the physician’s office. Although the patient is awake during the entire procedure, discomfort is usually minimal and no greater than it would be for more routine skin cancer surgeries. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all “roots” and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.
Physicians performing Mohs surgery should have specialized skills in dermatology, dermatologic surgery, dermatopathology, and Mohs surgery. Basic and advanced training in Mohs surgery is available through selected Residency programs, specialized fellowships, observational preceptorships, and intensive training courses. In addition, the Mohs surgeon must have the required surgical and laboratory facilities and must be supported by a well-trained Mohs nursing and histotechnological staff.
Some skin cancers can be deceptively large – far more extensive under the skin than they appear to be from the surface. These cancers may have “roots” in the skin, or along blood vessels, nerves, or cartilage. Skin cancers that have recurred following previous treatment may send out extensions deep under the scar tissue that has formed at the site. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous “roots.” For this reason, prior to Mohs surgery it is impossible to predict precisely how much skin will have to be removed. The final surgical defect could be only slightly larger than the initial skin cancer, but occasionally the removal of the deep “roots” of a skin cancer results in a sizeable defect. The patient should bear in mind, however, that Mohs surgery removes only the cancerous tissue, while the normal tissue is spared.
It is important to note that Mohs surgery is not appropriate for the treatment of all skin cancers. Mohs micrographic surgery typically is reserved for those skin cancers that have recurred following previous treatment or for cancers that are at high risk for recurrence. Mohs surgery also is indicated for cancers located in areas such as the nose, ears, eyelids, lips, hairline, hands, feet, and genitals, in which maximal preservation of healthy tissue is critical for cosmetic or functional purposes.
For more information please click here. The American Society of Mohs Surgery has prepared a short informational video to provide an overview of the Mohs technique and address frequently asked questions