What is Mohs Surgery?

Mohs surgery is named in honor of Dr. Frederic Mohs, the physician who developed the technique in the 1930’s. The main difference between Mohs surgery and other methods of removing skin cancer is microscopic control. In Mohs surgery, cancerous tissue is removed in horizontal layers. Each layer is divided into sections, and each section is carefully identified and mapped by the surgeon so its exact location can be pinpointed on the wound. Each tissue section is inspected under the microscope and, as long as cancer cells are seen within a section, the surgeon continues to remove and examine tissue layers from that part of the wound. Because the entire surgical margin of each layer is examined microscopically, the Mohs surgeon can be highly confident that all of the cancer has been eradicated and no malignant cells are left behind. In addition, because no healthy tissue is removed unnecessarily, smaller wounds and superior cosmetic results can be achieved.

What Are the Advantages of Mohs Surgery?

  • Highest cure rate (up to 99%)
  • Smallest possible wound
  • Optimal cosmetic result
  • Convenient — cancers are removed in one outpatient treatment session.
  • Cost-effective — fewer cancer recurrences, fewer return visits, no operating room fee, no anesthesiology fee.
  • Safe — avoids risks of general anesthesia.

Which Skin Cancers Should Be Treated With Mohs Surgery?

Mohs surgery is now universally recognized as a precise and effective method of treating skin cancers. It is especially effective in treating cancers of the face and other cosmetically sensitive areas because it can eliminate cancer cells while causing minimal damage to the surrounding normal skin.

Mohs surgery is also ideal for recurrent skin cancers – those that grow back after previous treatment and can plague a patient repeatedly. While skin cancers are often easily visible, individual cancer cells are microscopic. Root-like extensions of cancer cells may reach beyond the cancer’s visible borders with nests of cells growing in unpredictable areas. Therefore, what is apparent to the naked eye on the surface of the skin may actually be only the “tip of the iceberg.” Any cells left behind can cause the cancer to recur, just as roots left behind when pulling weeds may allow the weeds to regrow. With the Mohs technique, all tumor nests can be identified and removed with a high degree of accuracy, producing extremely high cure rates, as high as 99%, even for recurrent skin cancers. Other forms of treatment have success rates as low as 60% in curing these difficult cancers.

Who Performs Mohs Surgery?

Although the concept of Mohs surgery was developed in the 1930s, relatively few dermatologists were trained in its use until recently. Only in recent years has the technique become widely available throughout the country.

The American College of Mohs Surgery (ACMS) currently recognizes a limited number of training programs in the United States where highly qualified applicants receive comprehensive training in Mohs micrographic surgery. The training period is usually one to two years, during which time the dermatologist acquires extensive experience with all aspects of the technique. Once the physician’s training is successfully completed, he or she becomes eligible for membership in the American College of Mohs Surgery (ACMS).

Many dermatologists throughout the country have been trained in the basic micrographic surgical techniques and employ them in their practices. But when patients require more extensive surgery, they are referred to a member of the College.