Mohs Surgery

Mohs Micrographic Surgery Overview

Mohs Micrographic Surgery is the most advanced and effective treatment procedure for skin cancer available today. The procedure is performed by specially trained surgeons who have completed at least one additional year of fellowship training (in addition to the physician’s three-year dermatology residency) under the tutelage of a Mohs College member.

Initially developed by Dr. Frederic E. Mohs, the Mohs procedure is a state-of-the-art treatment that has been continuously refined over 70 years. With the Mohs technique, physicians are able to see beyond the visible disease, to precisely identify and remove the entire tumor layer by layer while leaving the surrounding healthy tissue intact and unharmed. As the most exact and precise method of tumor removal, it minimizes the chance of re-growth and lessens the potential for scarring or disfigurement.

Because the physician is specially trained in surgery, pathology, and reconstruction, Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99 percent. The Mohs technique is also the treatment of choice for cancers of the face and other sensitive areas as it relies on the accuracy of a microscopic surgical procedure to trace the edges of the cancer and ensure complete removal of all tumors down to the roots during the initial surgery.

Mohs Micrographic Surgery is an effective and precise method for treating basal cell and squamous cell skin cancers.

Because the Mohs Micrographic Surgery process surgery features a systematic microscopic search that traces skin cancer down to its roots, it offers the highest chance for complete removal of the tumor while sparing the normal tissue surrounding it.

Clinical studies conducted at various national and international medical institutions – including the Mayo Clinic, the University of Miami School of Medicine and Royal Perth Hospital in Australia – demonstrate that Mohs surgery provides five-year cure rates exceed 99 percent for new cancers, and 95 percent for recurrent cancers.

Why Does My Skin Cancer Need Mohs Surgery?

Mohs Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas, but can be used to treat less common tumors including melanoma.

Mohs Surgery is appropriate when:

  • the cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, fingers, toes, genitals;
  • the cancer was treated previously and recurred;
  • scar tissue exists in the area of the cancer;
  • the cancer is large;
  • the edges of the cancer cannot be clearly defined;
  • the cancer is growing rapidly or uncontrollably.

The Mohs Micrographic Surgery Process

Mohs surgery is usually an outpatient procedure performed in a physician’s office. Typically, it starts early in the morning and can be completed the same day, depending on the extent of the tumor and the amount or reconstruction necessary. Local anesthesia is administered around the area of the tumor so the patient is awake during the entire procedure.

Mohs Surgery Reconstruction- Repairing the Wound

The ACMS surgeon is also trained in reconstructive procedures and often will perform the necessary reconstruction to repair the wound.

As soon as the affected area is declared cancer-free, the Mohs surgeon discusses post-surgical options with the patient such as:

  • a small, simple wound may be allowed to heal on its own.
  • a slightly larger wound may be closed with stitches.
  • larger wounds may require a skin graft or a flap.
  • if the tumor is very large, another surgeon with special skills may be called upon to assist with reconstruction.

Mohs Micrographic Surgery Post-Surgical Management

Post-surgical check-ups are recommended in order to monitor the patient’s progress and spot any possible cancer recurrence in a timely manner.

Since two of five patients with one skin cancer will develop another within five years, follow up is extremely important for early detection of any new lesions.

Mohs Micrographic Surgery: Patient Education Video

Watch the Mohs College patient education video. It covers all the basics of skin cancer and details of the Mohs Surgery process. The clip is 9 minutes and 20 seconds long. The broadband version is higher in resolution and takes longer to download.

Mohs Micrographic Surgery: Cost Effectiveness

As the incidence of skin cancer soars, greater focus is currently being placed on the cost effectiveness of treatment. Over the past decade, studies have been conducted to calculate and compare the costs of Mohs Micrographic Surgery with those of traditional surgical methods. Studies cited in Journal Watch Dermatology show that Mohs surgery is no more costly than standard excision and less expensive than radiation therapy or excision in an ambulatory surgery center. Because the process of Mohs Surgery minimizes the risk of recurrence, it reduces and frequently eliminates the costs of larger, more serious surgery for recurrent skin cancers.

The Cost of Mohs Surgery vs. Excision

George J. Hruza, MD Published in Journal Watch Dermatology March 28, 2006
covering: Essers BA et al., Arch Dermatol 2006 Feb; 142:187-94

Mohs Surgery and Excision: Comparing the Costs

George J. Hruza, MD Published in Journal Watch Dermatology June 30, 2004
Covering: Bialy TL et al., Arch Dermatol 2004 Jun; 140:736-42

History of Mohs Micrographic Surgery

Mohs Micrographic Surgery is named after its founder and originator, Frederic E. Mohs, MD. As a medical student from 1929 to 1934, Dr. Mohs conducted cancer research projects while working for his mentor and zoology professor, Michael Guyer. Dr. Guyer was familiar with the preparation of frozen tissue for producing microscopic slides and had authored a book explaining how to harvest and process tissue for microscopic examination. The book focused on the need for examining, drawing and documenting discoveries that were made with the microscope.