Mohs Micrographic Surgery, also called chemosurgery or simply Mohs Surgery, represents an long legacy of successful skin cancer treatment. Despite its discovery by Dr. Mohs in the 1970s, Mohs Micrographic Surgery remains a central tool against skin cancer to this day, simply because it is one of the most effective and advantageous treatments available.
Why do we call it “advantageous”? Because in addition to being effective, Mohs Micrographic Surgery is also low-risk, with very few reported complications either during or after surgery. In addition, Mohs Micrographic Surgery focuses on the complete removal of any cancerous tissue in one fell swoop, and without the need for general anesthetic.
For starters, the leading physician performing the surgery on a patient must hold the surgical subspecialty related to the procedure as recognized by the ACMMSCO, or American College of Mohs Micrographic Surgery and Cutaneous Oncology. This is the only governing body that may award such a subspecialty to a surgeon, and only after a stringent experience-based exam process.
In addition to the lead physician, the procedure is performed by a team of specialized personnel that also includes nurses and technicians, each of whom play an important role.
The innovation of Mohs Surgery is found in its combination of simplicity, technology, and thoroughness. A local anesthetic is used on the suspicious tissue(s). Visible tumors are scraped away with a surgical instrument, after which samples are taken from the areas of tissues surrounding the tumor site.
These samples are examined under a microscope, starting with tissues that originated close to the tumor site and gradually expanding outward. The samples are examined for any evidence of cancerous cells. This process allows the team to ascertain the extent and proximity of any remaining cancer cells after the initial removal of the visible tumors.
More layers of tissue may be taken as needed, usually requiring a maximum of two or three layers of tissue to complete the investigation. Bleeding is controlled using simple pressure or other routine measures, although sometimes a small blood vessel may require suturing.
Actual surgical procedure only requires between 20 to 30 minutes, while the tissue examination process can take an hour or more for each layer that is sampled and examined. During this time, the patient is asked to wait and is fully conscious.
If the Mohs Surgery procedure starts in the early morning, it can generally be completed in one day. If the presence of cancerous cells turns out to be extensive, however, a second day of surgery may be necessary.
Every effort is taken to minimize total scar tissue and the appearance of any scarring. Based on the severity of the surgical wound, healing may be allowed to proceed naturally with or without stitches, as needed. When the surgical wound is more pronounced, numerous options exist to deal with it, including Skin Graft (the use of skin from a different body site on the wound site), or Skin Flap (skin adjacent to the wound site is used to conceal scar tissue).
Mohs Surgery remains a centerpiece of skin cancer defense for nearly 40 years. Why? Because it offers the highest possible degree of certainty that all of the cancer has been removed with the least amount of risk. That’s also why we offer it: for an end to skin cancer, we trust the procedures that work.