Mohs

Mohs Micrographic Surgery

Mohs micrographic surgery, commonly referred to as Mohs surgery, is a precise surgical technique used to treat skin cancer. Developed by Dr. Frederic E. Mohs in the 1930s, this procedure is renowned for its high cure rate and tissue-sparing properties. It is primarily used to treat basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the two most common types of skin cancer.

History

The technique was developed by Dr. Frederic E. Mohs, a general surgeon, who initially called it "chemosurgery" due to the use of a chemical fixative. Over time, the procedure evolved to use fresh tissue, allowing for immediate microscopic examination of the excised tissue.

Procedure

Mohs surgery is performed in stages, including:

1. Excision: The visible tumor is surgically removed with a thin layer of surrounding tissue.
2. Mapping and Orientation: The excised tissue is mapped and marked to maintain orientation.
3. Microscopic Examination: The tissue is frozen, sectioned, and examined under a microscope to check for cancerous cells.
4. Additional Excision: If cancerous cells are found at the margins, additional layers are excised and examined until clear margins are achieved.

This stepwise approach ensures that all cancerous cells are removed while preserving as much healthy tissue as possible.

Indications

Mohs surgery is indicated for:

• Skin cancers with poorly defined borders
• Recurrent skin cancers
• Cancers located in cosmetically sensitive areas (e.g., face, ears, hands)
• Large or aggressive tumors

Advantages

The primary advantages of Mohs surgery include:

• High Cure Rate: Mohs surgery has a cure rate of up to 99% for primary BCC and SCC.
• Tissue Conservation: By removing only cancerous tissue, Mohs surgery minimizes scarring and preserves healthy tissue.
• Immediate Results: The entire procedure, including pathology, is completed in one visit, providing immediate results.

Limitations

While Mohs surgery is highly effective, it may not be suitable for all types of skin cancer, such as melanoma, unless specific techniques are used. It is also a time-consuming procedure that requires specialized training and equipment.

Training and Certification

Dermatologists and surgeons who perform Mohs surgery undergo specialized training in dermatologic surgery and pathology. Certification is often provided by professional organizations such as the American College of Mohs Surgery.

Also see

• Basal cell carcinoma
• Squamous cell carcinoma
• Skin cancer
• Dermatology
• Surgical oncology