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What is Mohs microsurgery?

Mohs micrographic surgery is a highly specialized surgical procedure for the removal of skin cancers. It minimizes the potential for scarring and is the most exact and precise method currently available for removing skin cancer. Mohs surgery is typically used to treat the two most common forms of skin cancer, basal cell carcinoma and squamous cell carcinoma, but has been used successfully for melanoma and many other types of skin cancer.

Why it's done

Though there are a variety of ways to treat skin cancer, the Mohs technique combines the most complete microscopic margin control with the most conservative amount of skin removal.

Skin cancers often have roots that are not visible to the naked eye but are visible microscopically, and this root system must be removed for a successful cure. Mohs surgery is very useful for skin cancers in cosmetically sensitive areas of the face where preservation of healthy skin is of utmost concern, such as the ears, lips, nose or near the eye. It is also recommended for tumors that are large or have aggressive root systems. In addition, tumors that have indistinct clinical margins are best treated with Mohs surgery.

Our approach

During Mohs microsurgery, a specially-trained physician shaves one thin tumor layer at a time from the skin, examining each under a microscope for skin cancer. Surgery is stopped when no more disease is visible, leaving as much healthy tissue as possible. This procedure attempts to preserve the skin’s appearance as much as possible and minimize aesthetic impact.

Success statistics

Of all the treatments for skin cancer, Mohs micrographic surgery offers the highest cure rate (up to 99 percent) and the lowest chance for regrowth.

What to expect

Mohs surgery is performed by using a microscope to scan the entire edge and base of the skin that will be surgically removed. The surgeon then removes the cancerous skin in layers.

For the first layer, the surgeon removes the cancer that is visible on the surface of the skin, along with a very small, 1-2 millimeter margin of healthy appearing skin. The tissue that is removed is rapidly processed onto glass slides in the on-site Mohs laboratory. The complete edge and base of the tissue is examined with a microscope, and if residual cancer is identified, its location is precisely noted and the Mohs surgeon can return immediately to remove more skin for analysis. Once all cancerous tissue is removed, the resulting wound is closed.

The entire procedure can take several hours depending on how many layers are required to remove the cancer. Therefore, patients must be able to tolerate prolonged outpatient surgery using local anesthesia. Most of the patient's time is spent relaxing and waiting for the tissue to be processed and examined in the Mohs laboratory.

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