The name “Mohs” originated from Dr. Frederic Mohs, a Professor of Surgery at the University of Wisconsin who developed the technique in the 1940’s and 1950’s. During subsequent years, the technique has been refined and is now called Mohs Micrographic Surgery in honor of Dr. Mohs.
Mohs Micrographic Surgery (Mohs Surgery for short) is a highly precise method of removing skin cancer in which the diseased tissue is removed in stages. Surgery is performed in an outpatient setting under local anesthesia. Some skin cancers appear small on the surface of the skin, but actually enlarge as they go deeper. These “roots” may be unpredictable and invisible to the naked eye. Mohs Surgery was designed to track the roots under the microscope to ensure that they are completely removed. Differing from standard surgical excision, Mohs surgery is unique in the method of removal of the affected skin tissue and how it is processed and examined. Although plastic surgeons and other specialists check excision margins, the level of precision is not the same as in Mohs Surgery.
During standard excision, a football shaped piece of tissue including the skin cancer is removed. The tissue is sliced top to bottom and laid onto slides for examination. Unfortunately, only about 1% of the surgical margin can be examined this way. While this is usually adequate for skin cancers on the arms, torso or legs where there may be extra skin to take a wide margin, it is not good for cosmetically sensitive areas such as the face.
Mohs Surgery involves removing the skin cancer in stages that begin with a saucer-like piece of skin that includes the tumor plus a small margin of normal skin. The tissue is mapped, inked and processed onto slides for examination in such a way that 100% of the surgical margin can be examined. When skin cancer cells are seen in the removed tissue, another stage is removed in the exact location, leaving normal skin intact. By this method, as much normal skin is saved as possible. Once the skin cancer has been completely removed, Dr. Schlesinger will explain options for repair of the wound, which may include natural healing (granulation), stitching the wound together side-to-side, or closure using a skin flap or graft.
Because the Mohs Micrographic Surgery process involves a systematic microscopic search that traces skin cancer roots until they are gone, it offers the highest chance for cure while sparing the normal tissue surrounding them. Studies performed around the world have repeatedly demonstrated that Mohs surgery has a 99% five-year cure rate for new skin cancers and a 95% rate for recurrent cancers.
Physicians may receive training in dermatology residency programs, through fellowships, courses and preceptorships. Dr. Schlesinger has satisfied the training and testing requirements to become a Fellow of the American Society for Mohs Surgery, a professional organization dedicated to Mohs with over 850 members. As a surgical graduate of the world renowned Cleveland Clinic Foundation, he also received training in Mohs Surgery and additional post-graduate training at the Scripps Clinic in La Jolla, California. Having extensive experience performing Mohs surgery and post-Mohs reconstruction, Dr. Schlesinger has performed this type procedure for over 10 years. Dermatologists are uniquely qualified to perform Mohs largely due to their training and expertise in skin cancer pathophysiology, cutaneous (skin) histopathology, dermatologic surgery, and repair of complex defects.
Mohs Micrographic Surgery is usually used to treat basal cell carcinomas and squamous cell carcinomas.
Mohs Surgery is performed as an outpatient under local anesthesia. Meaning that the area to be treated is numbed and kept numb throughout the procedure until you go home. The day will start in the morning, usually between 8am and 9.30am. You are asked to have breakfast, take your medications and drink plenty of water in the morning. Please avoid caffeine as it may interfere with the anesthesia and make sure to ask Dr. Schlesinger or his staff about any prescription medications before your surgery date.
After you are comfortable and the first stage has been removed, you will wait in one of our comfortable lounges for the 20-40 minutes it takes to process your tissue and read the slides. Please bring a blanket, something to read or occupy your self. We ask that you limit the number of accompanying family or guests to one person and that no children be brought with you or your guest on the day of surgery. Our Mohs lounge is complete with television, reading material and plenty of decaffeinated coffee and water. If necessary, you will be called in for a second or additional stage. Once the cancer has been completely removed, your reconstruction will be discussed and planned with you and performed in one of our surgical suites.
With the rising incidence of skin cancer, much emphasis has been placed on cost effectiveness of treatment. Studies have been performed over the past ten years to calculate and compare the costs of Mohs Surgery to conventional surgical removal. Studies have shown that Mohs Surgery is no more costly than standard excision and is less expensive than radiation therapy or excision in an ambulatory surgery center. Because the method of Mohs minimizes the chance for recurrence, it often reduces the need for larger, more costly and more serious surgery for recurrent skin cancers.
The Cost of Mohs Surgery vs. Excision
George J. Hruza, MD Published in Journal Watch Dermatology March 28, 2006
covering: Essers BA et al., Arch Dermatol 2006 Feb; 142:187-94
Mohs Surgery and Excision: Comparing the Costs
George J. Hruza, MD Published in Journal Watch Dermatology June 30, 2004
Covering: Bialy TL et al., Arch Dermatol 2004 Jun; 140:736-42
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Dr. Schlesinger and our staff are members of the following organizations:
