About Mohs Surgery
What is Mohs Surgery?
Mohs surgery can be described as the surgical removal of skin cancer and other appropriately-indicated malignancies followed by microscopic examination of graphically-oriented, oblique tangential histologic sections of the entire surgical margin of excised tissue, to ensure the complete removal of the malignant tissue.
In other words, the Mohs surgeon removes the first level of cancerous tissue, draws a corresponding diagram or “map” to ensure proper orientation on the patient, and the Mohs technician efficiently sections and stains the tissue to prepare a microscope slide. The Mohs surgeon then “reads” the slide to determine which margins still contain cancer cells. This process is repeated until the lesion and any cancerous “roots” have been completely removed. At this time the surgeon closes the surgical defect using one of a variety of simple to complex reconstruction techniques.
Patient Preparation for Mohs Surgery
Prospective patients may wish to review our patient education video for an introduction to the Mohs procedure as well as review our FAQ section. If you have been diagnosed with a skin cancer for which Mohs surgery is indicated, the video will answer many of your questions. Please discuss any additional concerns with your dermatologist or Mohs surgeon. Find a Surgeon »
Please review The Mohs Surgical Procedure and History of Mohs Surgery sections on this site for additional information on the Mohs technique. If Mohs surgery is not determined to be the optimal treatment for your particular condition, your dermatologist or Mohs surgeon will recommend alternative therapies.
Why choose Mohs surgery?
There are two main benefits to enlisting a Mohs surgeon to remove your basal cell or squamous cell carcinomas, along with many melanomas. First, this method ensures your cancer will be fully removed: Mohs has a 99 percent cure rate. That’s a number not even approached with other surgical methods.
Second, Mohs surgery guarantees your surgeon will only take the minimum amount of skin necessary to remove the skin cancer. That’s because Mohs is performed in stages, with each removed sample being tested, until the sample is clear of all cancerous cells. With traditional skin cancer removal, doctors must take a larger area around the lesion to hopefully remove all the cancer cells. This takes a larger amount of healthy, cancer-free skin than with Mohs methods.
What does “Mohs” stand for?
Mohs surgery for skin cancer gets its name from the surgeon who developed the technique, Dr. Frederic Mohs. Dr. Mohs was a general surgeon at the University of Wisconsin. He initially developed the technique of involving microscopic control in the 1930s, but it wasn’t until the late 1950s and 1960s that he began using these techniques on basal cell carcinomas and squamous cell carcinomas. These surgeries showed incredible five-year cure rates of 100 percent. That was the true beginning of Mohs surgery for skin cancer.
I don’t see anything after my biopsy. Do I really need to be treated?
The biopsy taken by your dermatologist was only meant to find out if the suspicious-looking lesion or area of your skin contained skin cancer. It was in no way intended to remove all of the cancer. Sure, there is a chance the curette took all the cancer cells with the rest of the biopsied tissue. But there’s a far greater chance that groups of cancer cells are in the surrounding tissue (beyond the biopsy), and they may not be numbers sufficient to yet show any signs on the surface skin. Still, they’re likely to exist.
The only way to know if all the cancerous tissue was removed is to perform Mohs surgery and to immediately test the outer ring of the sample. This thoroughness provides the best chance that your surgeon will take out all the cancer cells. Hoping that your biopsy removed all the cells simply because the surrounding skin isn’t showing signs of skin cancer is truly rolling the dice.
How long does Mohs surgery take?
Whenever an incision is made in human skin a scar will form. That’s just the way our skin heals as new amounts of collagen are produced and sent to heal the wound. This is what scar tissue is made of.
The nice aspect of Mohs surgery is that it enables your Mohs surgeon to preserve as much healthy tissue as possible, while still being able to be sure that he has removed all the cancer cells.
This isn’t the case with traditional excisional methods, as it is usually necessary to take a far larger border around the lesion just to be sure it’s hopefully wide enough to get all the cancer. Mohs surgeons have extensive training and specialized surgical expertise ensuring you’ll have the smallest scar possible. They are also excellent with subsequent options for minimizing your scarring, such as the possible use of a skin flap.
Does skin cancer return after Mohs surgery? How effective is Mohs surgery?
Mohs surgery has the lowest recurrence rates, highest cure rates, and best cosmetic results of any skin cancer treatment, according to the Skin Cancer Foundation. Mohs surgery has over a 99 percent cure rate on skin cancers that were not previously treated. On areas that were previously treated with other excision methods and the cancer was not fully removed, Mohs is 94 percent successful.
Is Mohs surgery painful, and will I have anesthesia for this surgery?
Modern local anesthesia is such that you won’t feel a thing during your Mohs surgery. Local anesthesia is used to allow the patient to do other things while awaiting the test results from the sample removed. Plus, these are not massive incisions; general anesthesia is not necessary. There will be some discomfort as the incision heals. This usually only requires over-the-counter pain medication. These surgeries do not involve much acute pain.