What is Mohs Micrographic Surgery?
Mohs Micrographic Surgery (referred to as simply Mohs or Mohs Surgery) was first developed by Dr. Frederic Mohs, a Professor of Surgery at the University of Wisconsin, in the 1930s. Throughout the years it has evolved into the highly precise removal of skin cancer in which damaged cells are removed in stages as opposed to a large area being removed at once. This type of removal ensures all margins are clear and there are no remaining “roots” of the skin cancer that extend beyond the visible surface.
We know what you’re thinking: Why would my dermatologist recommend Mohs Surgery as opposed to a regular excision? While there are a couple of different reasons Mohs Surgery would be recommended over a standard excision, such as the size and aggressiveness of the skin cancer, the location, whether it has clearly defined borders, to name a few.
Mohs Surgery is most often recommended for basal cell carcinoma and squamous cell carcinomas located on the face, ears and hands where there is little excess skin to cut a wider margin. The process allows for the least amount of skin to be removed while still clearing all margins of damaged cells. With standard excisions to remove skin cancers on the arms, legs, back or torso, a football shaped piece of tissue is removed to cover a wider margin where the roots of a skin cancer may have reached. These areas also tend to heal with less chances of scaring as the skin has a greater amount of elasticity.
Try this: Pinch an area of skin on your arm and then try to pinch the same amount of skin on your forehead. Notice a difference in how much skin is available? Now think about a skin cancer being removed in those areas.
For Mohs Surgery your pathologist is your surgeon and in the case at our office, Dr. Schlesinger is both your surgeon and the pathologist, reading the slides. If the margins are not clear on the slide, he returns to remove another outline of the area to be examined. (This can continue for as many stages as needed until all margins are marked clear, generally no more than 2 but at times up to 4 or 5.)
Once the site is cleared, it’s time to move on to the closure. In our office, Dr. Schlesinger handles 99% of our Mohs Closures and does so by using a variety of plastic surgeon-like techniques to reduce scarring as much as possible. Depending on the size and location of the skin cancer, a skin graft may be required, but all is taken care of the same day as the removal.
All dermatologists receive training in Mohs Surgery during dermatology residency programs, however not all dermatologists complete the advanced training requirements needed to become a Fellow of the American Society for Mohs Surgery and hold the title of a Mohs Surgeon. We are proud to have Dr. Schlesinger in our office who is a Fellow of the ASMS and has been performing Mohs Surgery for over a decade, reading the prepared slides and performing the surgeries in office.
Now compared to a standard excision, which is an hour or so visit to the office, this all may sound like a major surgery to have, however at DLCC it is taken care of in one day and under local numbing. No anesthesia required (and no anesthesiologist fees, either)! Our Mohs Surgery patients are prepared to spend a good portion of the day at our office and adequately prepped with pre and post care instructions before even stepping through the front door. (April, our Surgical Coordinator, takes great care of her patients making sure they are well prepared for their surgery day!) They even enjoy light breakfast snacks and are sent home with instructions, bandages and a few helpful items to assist with their recovery process. And as an added bonus, you won’t need to worry about a facility fee that you may find at a hospital or clinic.
Regardless of the type of removal recommended for your skin cancer, the most important part of the entire process is catching your skin cancer in the earliest of stages. And that is done by having regular full body skin exams with a board-certified dermatologist or certified dermatology physician assistant. Once the cancerous lesion is identified, the next step is deciding which removal process is best for your particular case and moving forward from there.
If you have any questions on Mohs Surgery or would like to schedule an appointment to have a suspicious mole checked, please don’t hesitate to contact our office as our staff is always here to answer your questions. If, by chance, your primary care physician or general practitioner diagnose you with a basal cell carcinoma or squamous cell carcinoma, verify you are being sent to a dermatologist who is also a Mohs surgeon to receive a balanced and objective view on the best possible removal process.