Dr. Frederic Mohs developed Mohs surgery in the 1930s and the procedure has been refined and updated for modern use. Dr. Mohs realized that skin cancer is like the “tip of the iceberg” and that what we see is only the outward manifestation, but that the cancer grows into the skin like the roots of a tree and is only visible with microscopic analysis. Mohs surgery gets to and removes the roots of nonmelanoma skin cancer.
What is Mohs surgery?
MOHs surgery is a specialized surgical procedure to remove basal and squamous cell lesions. It is reserved for cancer removal in areas that are near important features and provides the most cosmetically acceptable scars. Mohs is the least invasive and most effective treatment for nonmelanoma skin cancers. Reported five – year cure rates are 98% or greater for common nonmelanoma skin cancers. The high success rate is due to the fact that the excised tissue is examined by the surgeon, under a microscope during surgery, and not after the tumor has been removed. This eliminates the situation where the tumor was excised, the wound closed, and the tissue is sent to a pathologist for examination, only to discover that tumor cells still exist necessitating a second surgery.
How is Mohs surgery performed?
Mohs surgery is a highly specialized and precise procedure performed by surgeons with advanced training who act as both surgeon and pathologist. It is performed in an outpatient setting, usually the doctor’s office, under local anesthesia.
The area to be treated is numbed, and the lesion is removed one layer at a time. It is then prepared with colored dyes and is examined under a microscope to identify and map the microscopic roots of the cancer. The procedure is repeated until no tumor cells can be detected under microscopic examination. The wound is repaired to ensure limited scarring. Scars will improve with time. After the surgery you will wear a bandage until the sutures are removed 5-7 days later.
It usually takes about an hour to remove a tissue sample and examine it for cancer cells. While it can take a day to go through all the stages to remove the tumor, this process eliminates the need to overestimate the depth of the tumor and allows for preservation of greatest amount of noncancerous tissues. The outcome is significantly better cosmetic results than those that can be achieved with excisional surgery.
Side effects include swelling, bruising, tenderness and tightness at the site while the tissue heals. This is normal and temporary. Complete healing can take 3-12 months depending on the extent of surgery. Risks are the same as with any surgical procedure.
When is Mohs surgery recommended?
This highly technical surgery is usually reserved for certain circumstances, specifically:
- To remove nonmelanoma skin cancer, and especially scarring Basal cell carcinomas that are in a cosmetically sensitive area, near important features; and to preserve healthy tissue for the best aesthetic and functional outcome. Cosmetically sensitive areas include the face, nose, lips, eyelids, ears, fingers, toes and genitals.
- When the tumor is large and has indistinct margins.
- When there is a high risk of recurrence.
- To remove a recurrent skin cancer.
- When the tumor is located near scar tissue.
- When the tumor is aggressive and fast growing.
What are the advantages of Mohs surgery?
The major advantage of Mohs surgery is that the process ensures that 100% of tumor is removed and the maximum amount of healthy tissue is preserved which provides the best cosmetic result.
Dr. Joseph Sadek is a board-certified and fellowship trained dermatologist and Mohs surgeon and founder of The Texas Cancer Center with offices in Houston, Kingwood and Sugarland, Texas. When you need a good dermatologist, who provides state-of-the-art treatments and procedures in a compassionate and respectful setting, contact the Texas Cancer Center.