Mohs micrographic surgery is the best way to remove many types of skin cancer with the lowest chance of the cancer coming back. In fact, skin cancers treated with Mohs are cured over 99% of the time!
How does it work?
After removing the skin cancer, the histotechnologist freezes the specimen, stains the tissue, and prepares the sections on glass slides. The mohs surgeon looks at 100% of the deep and lateral margins under the microscope to see if any cancer cells are still present, and the patient waits comfortably in the office (comfortable usually means usually listening to 60s hits, watching hgtv, eating snacks, and making friends with the other patients or chatting with the staff). If there are still cancer cells lurking on the edges, the tumor cells are marked out like a map and more skin is removed exactly where the tumor cells remain. Once there are clear edges everywhere, the surgeon repairs the patient’s wound with a line of sutures, a flap, a skin graft, or other reconstructive technique. All surgical procedures result in a scar but due to the expertise in reconstruction of the mohs surgeon and the amazing qualities of human skin, most patients find that their scars become very difficult to see or notice over time.
What types of cancers are treated with Mohs Surgery?
The most common types of skin cancers treated with Mohs Surgery are basal cell carcinoma and squamous cell carcinoma. These cancers appear most frequently on sun exposed areas in people with a history of sun damage. They are most common in fair-skinned individuals with a tendency to burn but can happen to anyone. Basal cell carcinoma is by far the most common but it is also fortunately the least dangerous. Mohs surgeons and dermatologists utilize certain criteria to determine if something is appropriate for Mohs Surgery, including location of the tumor as well as size. In general patients with BCC or SCC on the head and neck region, hands, genitals, or feet should be treated by a qualified mohs surgeon. For very superficial cancers topical therapies or less invasive scraping techniques may be appropriate. For BCC or SCC on the body surfaces, simple excision techniques are often used. Mohs Surgery is also used for many less common types of skin cancer, including Merkel cell carcinoma, DFSP, atypical fibroxanthoma, microcytic adnexal carcinoma, and many others. Mohs Surgery is not typically used for melanoma, as these are general treated with wide local excision.
How do you find a great mohs surgeon?
Finding a well qualified mohs micrographic surgeon is one of the most important aspects to having a great result with skin cancer treatment. ALWAYS MAKE SURE that your surgeon did a fellowship in Mohs Surgery or procedural dermatology that is accredited by the AMERICAN COLLEGE OF MOHS SURGERY. The website of the American College of Mohs Surgery (www.acms.org) also has a directory of accredited surgeons that allows you to search for the surgeons near you. Other groups, such as the American Society of Mohs Surgery are not the same and do not indicate adequate physician training.