Mohs Surgery: What You Need to Know

According to the National Institute of Health and the World Health Organization, skin cancer is the most common cancer both nationally and internationally. Becoming diagnosed with skin cancer should not be taken lightly, regardless of severity. There are a few options to consider in order to remove the skin cancer successfully. These include but are not limited to:

  • Excision
  • Cryosurgery (freezing)
  • Low dosage radiotherapy
  • Topical chemotherapy
  • Electrodessication and curettage (EDC)
  • Mohs surgery

Excision, as the name implies, involves removing the cancer surgically by excising approximately a 5-6mm border around the growth itself followed by suturing. Cryosurgery involves spraying the lesion, most frequently with liquid nitrogen. Low dosage radiotherapy, as the name suggests, consists of using radiation to reduce/eliminate malignant cells. Because radiotherapy has many side effects, it is not among the common treatment methods for skin cancer. Topical chemotherapy is used mostly for skin cancers that are on the surface, as it is quite ineffective for invasive non-melanoma carcinomas. EDC consists of alternating between using a curette to scrape off the cancer, and an electrosurgical device to denature layers of the dermis.

Mohs surgery presents a unique treatment method due to its minimal approach and precision. This type of surgery involves a Mohs fellowship trained dermatologist who acts as a surgeon, pathologist, and reconstructive surgeon. Because the procedure is microscopic, maximum precision is achieved. Dr. George Mikhail, author of Mohs Micrographic Surgery textbook, notes that the Mohs cure rate is approximately 99% for basal cell carcinoma, and approximately 95% for squamous cell carcinoma. Melanoma tends to vary depending on the expertise of the Mohs surgeon and the type of melanoma. However, a 2008 clinical trial by Bene et al. has shown a 95.1% cure rate for melanoma in situ (non-spreading).

Before explaining the procedure, it is imperative to discuss the general indications for the necessity of Mohs surgery. The Advanced Dermatology and Cosmetic Surgery is one of the largest dermatology practices in the United States, with over 100 locations nationwide. According to the organization, Mohs surgery is the treatment of choice when the patient presents:

  • A large cancer
  • Cancer with asymmetric borders (meaning that the edges are not clearly defined)
  • The cancer is in an area that has thin skin, and healthy tissue preservation is critical such as the head/neck, upper chest, and the genitals
  • If prior treatment has failed

These criteria have been confirmed by the American Academy of Dermatology et al. The procedure consists of excising the skin cancer in small increments. Then, the Mohs surgeon will utilize their skills in pathology to divide the layer of skin removed into sections. Dye is then applied to identify the tumor, and analyzed under the microscope to find any cancer remains. By doing this, the Mohs surgeon can map out the precise location of any remaining cancer cells. After, any remaining cancerous tissue is removed. This allows the surgeon to remove cancerous skin along with approximately a 1 mm margin of healthy skin surrounding the cancer to ensure maximum healthy tissue preservation.

Another study by Merit et al. in the Journal of the American Academy of Dermatology has conducted many tests which analyzed the “rate of major and minor complications as well as postoperative pain”. They have concluded that Mohs surgery has a high degree of safety and is well tolerated.

Overall, Mohs surgery is very promising due to its combination of a high cure rate with patient safety. Since the procedure stems from the late 1930s, it has gone through many trials, and technology has made the surgery more efficient. Because of the detailed work involved, Mohs surgery can be expensive, and therefore, must only be used when deemed necessary by a Mohs trained dermatologist. It is critical that you don't seek any dermatologist when going for a Mohs consult or procedure, but one who has been officially fellowship trained in Mohs surgery.

Ideally, the best way to cure skin cancer is to prevent it. Please find my previous Recnac article on skin cancer prevention linked here.

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SC Ali

About SC Ali

S.C. Ali is an author/editor. He has a degree in Chemistry, and is interested in the study and practice of medicine. His blog can be found here:

SC Ali

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