Mohs Micrographic Surgery

What is Mohs Surgery?

Mohs micrographic surgery is the most effective treatment for high-risk skin cancers. This specialized surgery combines pathology on the same day, which allows smaller amounts of tissue to be taken and examination of 100% of the tissue margin. Mohs surgery has the highest cure rate for skin cancers -- up to 99% for skin cancers that have not previously been treated.

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Why is Mohs surgery performed?
Mohs surgery is used to treat:
•    Basal cell carcinoma
•    Squamous cell carcinoma
•    Melanoma (slow Mohs or staged excision)
•    Other forms of skin cancer

Your doctor may choose this method to address skin cancer that is:
•    Cosmetically/functionally sensitive areas such as head and neck, hands, feet, shins
•    Large (i.e., > 2 cm)
•    Has aggressive pathology (i.e., infiltrative, poorly differentiated)
•    On a person with a suppressed immune system such as after an organ transplant, lymphoma 
•    Recurring after previous treatment or radiation

Mohs Procedure: What to Expect
Mohs surgery takes place in an outpatient setting, usually lasting 2 to 4 hours on average. Local anesthetic is used to numb the area, and the skin cancer is precisely removed in layers. 

After each layer of tissue is removed, the specimen is frozen, sliced into very thin sections and processed onto glass slides by a Mohs histotechnician, a professional who is specially trained in preparing these slides. This process typically takes approximately one hour per stage.
 

The Mohs surgeon then examines the slides under the microscope to assess the extent of the skin cancer and identify any microscopic roots. If tumor cells remain at any of the margins, an additional tissue layer is taken at the area of involvement. This procedure continues until the tissue is cancer-free, which spares the maximum amount of healthy surrounding tissue.
 

Once the skin cancer has been completely removed, the defect is repaired on the same day. The reconstruction is designed to optimize cosmetic appearance of the surgical site. Dissolving stitches are commonly used in low tension areas, and non-dissolving stitches are used in areas with higher tension or movement. The Mohs surgeon will discuss the best options for each individual case.
 

Care After Mohs Surgery
The Mohs surgery team will bandage the surgical site, provide wound care instructions, and schedule follow-up to ensure a smooth healing process. After Mohs surgery, it is important to avoid strenuous activities for one to two weeks depending on the site and size of the surgery. Our goal is to provide complete care from start to finish of each skin cancer surgery!