Mohs Micrographic Surgery for Skin Cancer

There are few things in life as scary as learning that you have cancer. At Lakeside Dermatology, we’ve had to help our fair share of patients through this frightening diagnosis. As dermatologists, we deal with skin cancers. There are many different types of skin cancer, but the three major types of skin cancer are basal cell carcinomas (BCCs), squamous cell carcinomas (SCCs), and melanomas. Mohs micrographic surgery can be an effective treatment for all three types of cancer, though with melanomas it is generally only utilized in the very early stage of the disease.


What Is Mohs Micrographic Surgery?

In the 1930s, Dr. Frederic E. Mohs developed a technique called “chemosurgery.” This unique approach made use of a zinc chloride solution to remove and preserve tissue from a patient in such a way that it could be analyzed under a microscope and examine 100% of the margin.  At its inception the process could take several days. Over the years, the procedure was refined and became what we know today as “Mohs micrographic surgery,” where the doctor is both the surgeon and the pathologist. Most of the time Mohs surgery and reconstruction can be completed in a single day.  


Only certain skin cancers meet criteria for Mohs micrographic surgery. If your doctor deems it necessary, they will take a look at the tumor to determine what position will give them the best access and situate you accordingly. The tumor is then identified, marked and the site is confirmed with the patient. The Mohs surgeon will then remove cancerous tissue with a thin margin of clinically normal-appearing tissue. The tissue is then taken to the lab for analysis while the patient is bandaged and waiting. The tissue is oriented and processed and then the Mohs surgeon steps into his second role as a pathologist. They will look at the tissue under a microscope and make note if any residual cancer is observed. If there is residual cancer, additional tissue will need to be taken. Since the specimen was oriented, the Mohs surgeon can then very precisely excise further tissue where the cancer cells are while preserving normal tissue. If no cancer is seen, the Mohs surgeon will discuss various reconstructive options to minimize the appearance of scarring. While the process can be a bit time-consuming, it is highly effective.


Mohs micrographic surgery can be performed as a simple outpatient procedure with just local anesthesia. It is highly successful, with a cure rate of 99 percent on skin cancer that has never been treated before, and up to 94 percent for skin cancers that have recurred after a previous treatment. This technique leaves minimal scarring. Depending on how much tissue had to be removed, the wound may or may not require stitches or skin grafting. Generally, the reconstructive repair is done immediately after the removal of diseased tissue.

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