Procedures

Moh's Micrographic Surgery

What is Moh's Micrographic Surgery?

Mohs micrographic surgery is a precise method for treating skin cancers. The procedure is named in honor of the physician who developed the basic technique, Dr. Frederic Mohs. Although Dr. Mohs concept was developed more that 50 years ago, relatively few dermatologists were trained in its use until recently. Only in the last few years has the technique become widely available throughout the country. Mohs micrographic surgery provides the highest possible cure rate of all skin cancer treatments.

When is Moh's Micrographic Surgery indicated?

Mohs micrographic surgery is especially effective in cancers of the face and other cosmetically sensitive areas, because it can eliminate virtually all the cancer cells while causing minimal damage to the surrounding normal skin. The procedure is also ideal for the removal of recurrent skin cancers, in addition to skin cancers which have poorly defined clinical margins.

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How does Moh's Micrographic Surgery differ from other skin cancer treatments?

The main difference between Mohs micrographic surgery and other methods of removing skin cancers is microscopic control. In Mohs surgery, multiple thin horizontal layers of the cancer are removed. Each layer is "mapped" by the surgeon so that its exact location can be pinpointed on the wound. Every layer of tissue removed is then inspected under the microscope. If cancer cells are seen anywhere within the specimen, the surgeon continues to remove and examine tissue layers from that section of the wound until none are present. The procedure thus provides the highest level of confidence that all tumor cells have been removed, in addition to saving as much normal skin as possible.

How will the surgical defect be repaired?

The size of the surgical defect is determined by the degree of tumor involvement and is not known until after the Mohs micrographic surgery has been completed. In the majority of cases, the defect is repaired either by side to side closure, or by a skin flap (when excess skin adjacent to the wound is lifted and moved over the defect.) On rare occasions, a skin graft may be required. Great care is taken to repair the defect in the most cosmetic and functional manner possible.

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What to expect on the day of surgery?

Mohs micrographic surgery is performed on an outpatient basis using a local anesthetic. The surgery usually begins early in the morning and is finished the same day. Laboratory preparation of the tissue and examination under the microscope are time consuming, during which time a temporary dressing is placed and the patient is allowed to rest comfortably in the waiting room. If more than one session are required to obtain tumor free margins, the procedure may require several hours for removal and repair of the surgical defect.

Rationale for Moh's Micrographic Surgery

As previously noted, Mohs micrographic surgery provides the highest possible cure rate for skin cancer treatments (as high as 95% in many cases.) The technique also produces the smallest possible wound in the removal of any given tumor. The smaller the wound, the greater are the chances for the best possible cosmetic result after the wound has completely healed. This is particularly important on the face, where cosmesis is of utmost concern to the patient and physician.

Finally, while the Mohs procedure is technically demanding, it is also highly cost-effective, because fewer return visits to the physician's office are needed for treatment of a recurring lesion.

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