What is Mohs Surgery?
Mohs micrographic surgery is the most advanced technique for removal of skin cancers offering the highest cure rate for basal and squamous cell carcinomas. Developed by Dr. Fred Mohs, Mohs surgery involves the systematic removal and analysis of thin layers of skin at the location of the skin cancer until the last traces of cancerous tissue have been eliminated. The immediate and complete microscopic examination and evaluation of excised tissue is what differentiates Mohs surgery from other cancer removal procedures. Only cancerous tissue is removed, minimizing both post-operative wound size and the chance of regrowth. This allows for the best cosmetic surgical reconstruction with minimal scarring or change in your appearance. High precision makes Mohs surgery ideal for the elimination of cancers in cosmetically important areas such as the face (nose, eyelids, lips, hairline), hands, feet and genitals. A Mohs surgeon performs the function of a surgeon, a dermatopathologist, and reconstructive surgeon on an outpatient basis under local anesthesia. Dr. Crotty is a specialist in Mohs micrographic surgery and trained under Dr. Fred Mohs while a resident at the Mayo Clinic.
What Are the Advantages of Mohs Surgery?
Since Mohs surgery consists of removing thin layers of cancer-bearing skin and microscopically examining the area until it is tumor-free, the MOHS surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye, therefore, even the smallest microscopic roots of cancer can be removed. It offers skin cancer patients the most minimal recurrence rate, in addition to optimal preservation of uninvolved tissue and, therefore, minimal scarring. In fact, Mohs surgery has been shown to have a 99 percent or better cure rate for basal cell carcinoma, the most common type of skin cancer.
How is Mohs Surgery Performed?
Mohs surgery is performed as an outpatient procedure and allows patients to return home the same day. It involves anesthetizing the area around the lesion and removing all the visible cancer cells, including a thin layer of healthy tissue. This procedure is unique because the patient waits while the specimen is cut into sections or wedges, stained and carefully oriented to a map. The specimen is frozen in a refrigerated chamber, and a microtome blade is used to shave a paper-thin layer of tissue from all the surfaces of the "crust." These thin slices are placed on a slide for examination under a microscope.
The Mohs surgeon carefully examines the specimen for extensions that might have breached the crust of healthy skin. If an extension is identified, it is compared to the map to pinpoint where it was located at the lesion site. The surgeon removes additional tissue from that location only and spares the healthy tissue in remaining sections.
Typically, as long as 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. Typically, most cancers are cleared in one or two stages.
Will the Surgery Leave a Scar?
Since Mohs surgery removes as little normal tissue as possible, scarring is minimized. After the skin cancer has been completely removed, a decision will be made on the best method for treating the wound created by the surgery. The site may be repaired the same day or at a later date. In addition to the repair, additional reconstruction may be necessary at a later date depending on the anatomic location, size of the cancer and excision site. Return visits will be scheduled for evaluation of the surgical site, bandage changes and removal of stitches.