Mohs micrographic surgery is the most effective and advanced treatment for skin cancer today. It offers the highest potential for cure – even if the skin cancer has been previously treated by another method. Mohs surgery should only be performed by Fellowship-trained Mohs Surgeons like myself. Mohs surgery treats skin cancer through a highly specialized and precise technique that removes the cancer in stages, one tissue layer at a time. Originally developed in the 1930s, by Frederic Mohs M.D., Mohs micrographic surgery has been refined into the most advanced, precise, and effective treatment for an increasing variety of skin cancer types. With the Mohs technique, physicians can precisely identify and remove an entire tumor while leaving the surrounding healthy tissue intact and unharmed.
Success Rate of Mohs Surgery
The Mohs procedure involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached (called clear margins). Because I am a fellowship-trained Mohs College surgeon I am specially trained as a cancer surgeon, pathologist, and reconstructive surgeon. Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%.
Advantages of Mohs Surgery
Mohs surgery is unique and so effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. The pathologic interpretation of the tissue margins is done on site by myself; specially trained in the reading of these slides and am best able to correlate any microscopic findings with the surgical site on the patient. Advantages of Mohs surgery include:
- Ensuring complete cancer removal during surgery, virtually eliminating the chance of the cancer growing back
- Minimizing the amount of healthy tissue lost
- Maximizing the functional and cosmetic outcome resulting from surgery
- Repairing the site of the cancer the same day the cancer is removed, in most cases
- Curing skin cancer when other methods have failed
Other skin cancer treatment methods blindly estimate the amount of tissue to treat, which can result in the unnecessary removal of healthy skin tissue and tumor re-growth if any cancer is missed. Mohs surgery minimizes the amount of healthy tissue removed thereby reducing the impact to the surrounding area. The aesthetic outcome of the surgery is optimized. Furthermore, the psychological impact of being subjected to multiple procedures when cancer recurs can be significant. Patients usually find it reassuring to know that their cancer has been treated with a single procedure that gives them the highest possible chance of complete cure.
Options for Reconstruction
I will be able to give you an idea of whether your reconstruction should take place immediately after surgery or be delayed until later, however, it's impossible to know the extent of the cancer in advance. After determining that the affected area is cancer free and reconstruction is necessary, I will review skin cancer reconstructive surgery options with you. Depending on the size of the tumor, depth of roots, and location, one of the following options will be selected:
- Small, simple wounds may be allowed to heal by themselves (process known as secondary-intention healing)
- Slightly larger wounds may be closed with stitches in a side-to-side fashion
- Larger or more complicated wounds may require a skin graft from another area of the body or a flap, which closes the defect with skin adjacent to the wound
- On rare occasions, the patient may be referred to another reconstructive surgical specialist
Our staff will arrange post-surgical check-ups after Mohs surgery to monitor your recovery and spot any possible cancer recurrence as soon as possible. Since 2 out of 5 patients with one skin cancer will develop another within 5 years, follow-up is extremely important for early detection of any new lesions.