Mohs micrographic surgery is the most effective method for removing certain skin cancers, particularly those that spread deep and wide with finger-like or root-like projections. Basal Cell Carcinomas and Squamous Cell Carcinomas of the skin spread in this fashion.
Mohs surgery is named for Frederick Mohs, the physician who developed the technique in the 1930's and first published his results in 1941.
This outpatient surgery is done under local anesthesia; the obvious skin cancer and a margin of surrounding normal tissue are removed. This tissue is then processed into slides for microscopic review by the doctor. After the tissue is examined under the microscope, it is determined if cancer cells remain and if so, their exact location. At this point, a second layer of tissue is removed and the process is repeated, layer by layer, until the excised tissue is free of cancer. Once the area is cancer free, the wound can be allowed to heal or can be repaired. Some of the options for repair include:
-simple closure with stitches
-reconstruction by another specialty surgeon
Every surgical procedure has potential risks. Mohs surgery complications may include:
-bleeding or hematoma formation
-a larger than anticipated wound
-loss of sensation in the area of skin treated
-slight muscle paralysis in the area treated
-in areas repaired with a graft or flap, there could be loss of a portion or all of this repair
requiring healing by granulation
-1 - 3% chance of cancer recurrence
After the surgery you will be instructed on how to care for your wound. Strict adherence to the wound care protocol is important.
Occasionally, the scar may need to be revised to achieve a better appearance or better function of the affected area. This is optional and is discussed with the doctor.