You may have heard of a specific type of surgery called Mohs surgery, named after its founder Dr. Frederic Mohs. The surgery is a microscopically controlled procedure typically used to treat the most common skin cancers—basal cell carcinoma and squamous cell carcinoma—and is designed to completely remove skin cancers while preserving the normal skin around it.
Mohs surgery is most commonly used for people with skin cancers on the face, neck, or hands; recurrent cancer at any site; a predisposition to multiple skin cancers; and rapidly growing or large tumors. The surgery offers the highest cancer cure rate (as high as 99%) while minimizing removal of the surrounding healthy tissue, making it an important choice for many skin cancer patients.
During Mohs surgery, layers of cancer-containing skin are progressively removed and examined by the surgeon under the microscope until all the cancer is gone. Once the cancer is removed, the area is typically repaired with stitches. The procedure is performed under local anesthetic, adding to the safety of the patient. The four steps are:
- Tumor removal: After the skin has been numbed, the visible tumor is surgically removed.
- Mapping: The removed skin is processed and marked with ink to maintain orientation under the microscope. A map is drawn reflecting the inking and its relationship to the surrounding structures. The tissue is then processed in the surgeon’s lab and turned into a microscope slide.
- Analysis: The surgeon then acts as the pathologist and examines the tissue under the microscope. If any of the tissue sections demonstrate that additional cancer cells exist, the physician will return to that specific area and remove an additional thin layer. The mapping process will once again take place, and the entire process will continue as needed until all cancer cells are completely removed. Most cancers are removed in one or two stages.
- Reconstruction: Reconstruction is designed to repair your skin and provide the best cosmetic results. Your physician will usually discuss the repair options after the cancer has been completely removed.
It is recommended that you take it easy for one to two weeks after surgery to help with healing. With most reconstructions stitches are removed a week or two later, and over a period of months patients experience continuing cosmetic improvement in the scar.
These days most Mohs surgeons are trained in highly competitive one-year Mohs surgery fellowship programs after their dermatology training.
Patients can learn more about Mohs surgery and get answers to the most-asked questions about the procedure on Dermatology Consultants’ website. And remember to schedule an annual full-skin exam with a board-certified dermatologist to catch skin cancer in its earliest, most treatable stages.
Dr. Joe Shaffer is a board-certified dermatologist with Dermatology Consultants, one of the largest private dermatology practices in the Twin Cities. He has performed more than 28,000 Mohs surgeries in his career and has been named to Minnesota Monthly’s Top Doctors and Top Doctors for Women lists several times.