Mohs Surgery Overview
Frederic Mohs developed the technique known today as Mohs micrographic surgery during the 1930s. His technique was extensively refined over the following decades. Today it is considered the most effective treatment for most types of skin cancer. For many skin cancers the success rate for Mohs surgery is up to 99%.
After the site has been properly cleaned and anesthetized, the surgery begins with the removal of the visible portion of the tumor by excision or curettage (debulking). Next, a thin layer of tissue is surgically excised around and underneath the site. This layer is generally only 1-3 mm larger than the clinical tumor. This tissue is then processed in a unique manner and examined underneath the microscope. On the microscope slide, Dr. Friedman or Dr. Perry examines the entire bottom surface and outside edges of the tissue. This tissue has been marked to orient top to bottom and left to right. If any tumor is seen during the microscopic examination, its location is established, and a thin layer of additional tissue is excised from the involved area. The microscopic examination is then repeated. The entire process is repeated until no tumor is found.
Benefits of Mohs Surgery
- Highest cure rate
- Evaluation of 100% of the surgical margin (By comparison, conventional pathologic analysis following an excision evaluates less than 1% of the surgical margin)
- Minimizing the amount of healthy skin removed
- Repairing the site on the same day the cancer is removed, in most cases
Mohs Micrographic Surgery is very useful for large tumors, tumors with indistinct borders, tumors near vital functional or cosmetic structures, and tumors for which other forms of therapy have failed.
Rest assured that your Mohs surgeon at Marietta Dermatology has the highest level of training possible. Dr. Friedman and Dr. Perry completed fellowships in Mohs micrographic surgery and are members of the American College of Mohs Surgery (ACMS). An ACMS surgeon is trained as a cancer surgeon, pathologist, and reconstructive surgeon. While Dermatologists can perform Mohs surgery without completing a fellowship, Dr. Friedman and Dr. Perry completed the additional training in order to be able to provide patients with the highest level of care possible.
In some cases it is beneficial to have a Dermatopathologist process and evaluate the tissue after removal by a Mohs surgeon. In these cases, the Dermatopathologist still evaluates 100% of the surgical margin, but it takes about 24 hours to get a result after the initial tissue is removed.