Mohs Surgery

Mohs surgery - offers the highest cure rate and highest potential for recovery of all treatments of skin cancer– even if the skin cancer has been previously treated.  The cure rates are up to 99% even if other forms of treatment have failed.  This technique allows dermatologists, trained in Mohs surgery, to see beyond the visible disease, and to precisely identify and remove the entire tumor down to its roots, leaving healthy tissue unharmed.  This minimizes the chance of cancer regrowth and lessens the potential for scarring and disfigurement.  This procedure is most often used in treating two of the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma, but is also used for the treatment of a variety of other less common skin cancers as well.  

Effectiveness: Clinical studies have shown that Mohs surgery has a five-year cure rate up to 99 percent in the treatment of basal cell and squamous cell carcinomas.

Treatment Issues: Common treatment procedures often prove ineffective because they rely on the human eye to determine the extent of the cancer. In an effort to preserve healthy tissue, too little tissue may be removed resulting in recurrence of the cancer. If the surgeon is overcautious, more healthy tissue than necessary may be removed causing excessive scarring.

Indications: Mohs surgery is primarily used to treat basal and squamous cell carcinomas, but can be used to treat less common tumors. Mohs surgery is indicated when:

  • the cancer was treated previously and recurred

  • scar tissue exists in the area of the cancer

  • the cancer is in an area where it is important to preserve healthy tissue for functional and cosmetic result, such as eyelids, nose, ears, lips

  • the cancer is large

  • the edges of the cancer cannot be clearly defined

  • the cancer grows rapidly or uncontrollably

 

Procedure: The Mohs process includes a specific sequence of surgery and pathological investigation. Mohs surgeons examine the removed tissue for evidence of extended cancer roots. Once the visible tumor is removed, Mohs surgeons trace the paths of the tumor using two key tools:

  • a map of the excised tissue

  • a microscope

Once the obvious tumor is removed, Mohs surgeons:

  • remove an additional, thin layer of tissue from the tumor site

  • create a "map" or drawing of the removed tissue to be used as a guide to the precise location of any remaining cancer cells

  • microscopically examine the removed tissue thoroughly to check for evidence of remaining cancer cells


If any of the sections contain cancer cells, Mohs surgeons:

  • return to the specific area of the residual tumor indicated by the map

  • remove another thin layer of tissue only from the specific area(s) where cancer cells were detected

  • microscopically examine the newly removed tissue for additional cancer cells


If microscopic analysis still shows evidence of disease, the process continues layer-by-layer until the cancer is completely gone.

Selective removal of only diseased tissue using Mohs Surgery allows preservation of much of the surrounding normal tissue. This systematic microscopic search reveals the roots of the skin cancer which is why Mohs surgery offers the highest chance for complete removal of the cancer while sparing the normal tissue. Cure rates exceed 99 percent for new cancers, and 95 percent for recurrent cancers.

Reconstruction: The best method of managing the wound resulting from surgery is determined after the cancer is completely removed. When the final defect is known, management is individualized to achieve the best results and to preserve function and maximize aesthetics. The Mohs surgeon is also trained in reconstructive procedures and often will perform the reconstructive procedure necessary to repair the wound. A small wound may be allowed to heal on its own, or the wound may be closed with stitches, a skin graft or a flap. On occasion, another surgical specialist with unique skills may complete the reconstruction.

Cost Effectiveness: Besides its high cure rate, Mohs surgery also has shown to be cost effective. In a study of costs of various types of skin cancer removal, the Mohs process was found to be comparable when compared to the cost of other procedures, such as electrodesiccation and curettage, cryosurgery, excision or radiation therapy. Mohs surgery preserves the maximum amount of normal skin which results in smaller scars. Repairs are more often simple and involve fewer complicated reconstructive procedures.

With its high cure rate, Mohs surgery minimizes the risk of recurrence and eliminates the additional costs of larger, more serious surgery for recurrent cancers. The Mohs procedure is performed in the surgeon’s office and pathological examinations are immediate. The entire process is usually completed in a single day.

The Mohs Surgeon: The highly-trained surgeons that perform Mohs surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. 

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