The Skin Cancer Foundation

Mohs Micrographic Surgery: An Overview

New treatments for skin cancer are appearing and evolving rapidly in recent years. However, one surgical technique has more than stood the test of time. Developed by Dr. Frederick Mohs in the 1930s, Mohs micrographic surgery has, with a few refinements, come to be embraced over the past decade by an increasing number of surgeons for an ever-widening variety of skin cancers.

Today, Mohs surgery has come to be accepted as the single most effective technique for removing Basal Cell Carcinomaand Squamous Cell Carcinoma(BCCs and SCCs), the two most common skin cancers. It accomplishes the nifty trick of sparing the greatest amount of healthy tissue while also most completely expunging cancer cells; cure rates for BCC and SCC are an unparalleled 98 percent or higher with Mohs, significantly better than the rates for standard excision or any other accepted method.

The reason for the technique’s success is its simple elegance. Mohs differs from other techniques in that microscopic examination of all excised tissues occurs during rather than after the surgery, thereby eliminating the need to “estimate” how far out or deep the roots of the skin cancer go. This allows the Mohs surgeon to remove all of the cancer cells while sparing as much normal tissue as possible. The procedure entails removing one thin layer of tissue at a time; as each layer is removed, its margins are studied under a microscope for the presence of cancer cells. If the margins are cancer-free, the surgery is ended. If not, more tissue is removed, and the procedure is repeated until the margins of the final tissue sample examined are clear of cancer. In this way, Mohs surgery eliminates the guesswork in skin cancer removal, producing the best therapeutic and cosmetic results.

In the past, Mohs was rarely chosen for Melanoma surgery for fear that some microscopic melanoma cells might be missed and end up spreading around the body (metastasizing). However, efforts to improve the Mohs surgeon’s ability to identify melanoma cells have led to special stains that highlight these cells, making them much easier to see under the microscope. Thus, more Mohs surgeons are now using this procedure with certain melanomas. With the rates for melanoma and other skin cancers continuing to skyrocket, Mohs will play an ever more important role in the coming decades.

Mohs Surgery - Related Articles

Mohs Micrographic Surgery

Saving Face — The Skinny on Mohs Micrographic Surgery for Skin Cancer

The Eyelids — Highly Susceptible to Skin Cancer

Mohs Micrographic Surgery

mohs3 mohs1 Mohs micrographic surgery has the highest cure rate for basal cell and squamous cell carcinomas and is the treatment of choice for locally recurrent skin cancers, offering cure rates of 95 to 97 percent. Use of any other method to treat local recurrences achieves a cure rate of only 50 to 60 percent.

Mohs surgery is unique in its precision. Instead of removing the whole clinically visible tumor and a large area of normal-appearing skin around it, the Mohs surgeon removes the minimum amount of healthy tissue and totally removes the cancer. Thin layers of tissue are systematically excised and examined under a microscope for malignant cells. When all areas of tissue are tumor-free, surgery is complete.

The technique has several major advantages. It preserves more normal tissue than any other method while at the same time allowing the surgeon to trace and eradicate areas of tumor that are invisible to the naked eye. The Mohs surgeon, after examining the tissue under a microscope, knows exactly how far the tumor extends. As a result, Mohs surgery is particularly suitable for the area around the eyes, and the nose, ears and mouth where the preservation of normal tissue is essential. Lastly, when other standard methods have been unsuccessful, Mohs surgery offers another chance for cure.

Saving Face

The Skinny on Mohs Micrographic Surgery for Skin Cancer

DAVID G. BRODLAND, MD

More than a million Americans will be treated for skin cancer this year and about one in five will develop a skin cancer in their lifetimes. The number of cases diagnosed every year is increasing at near epidemic rates and will continue to do so for the foreseeable future. The other bad news is that most skin cancers occur on the face, and can be very disfiguring. If you were to find yourself in this unfortunate but ever more common situation, how would you design the ideal skin cancer treatment? What would you do to save face?

You would develop a technique that would do two very important things. First, it would remove the cancer. Second, the removal would involve the least amount of healthy tissue to ensure the smallest possible wound. Small wounds heal better than large wounds and obviously the best wound is the one that has no cancer in it.

As it happens, Dr. Frederick Mohs came very close to achieving this ideal treatment in the 1930s. With a few refinements over the years, the Mohs surgical technique is now the most precise and effective way to treat skin cancer. This has resulted in the very rapid increase of its use for all sorts of skin cancers. Mohs surgery’s popularity is likely to keep increasing as the number of skin cancers continues to rise and as more people become aware of the advantages.