Skin Cancer: When Mohs Surgery is the Best Treatment

By Richard Torbeck, MD

With more people diagnosed with skin cancer in the U.S. every year than all other forms of cancer combined, it’s fortunate that highly precise Mohs surgery is an option for many skin cancer patients.

Mohs (pronounced “moes”) surgery, also known as Mohs micrographic surgery, is uniquely able to help surgeons see where skin cancers stop. This means that patients are able to keep as much healthy skin as possible, since only unhealthy skin is removed.

The two most common forms of skin cancer, basal cell carcinoma and squamous cell carcinoma, are most appropriate for Mohs removal, especially when they occur in vulnerable areas around the eyes, nose, lips, ears, scalp, fingers, toes, or genitals. Occasionally, Mohs surgery can also be used on certain cases of melanoma and other, rarer skin cancers.

Unlike other types of skin cancer surgeries, Mohs surgery immediately allows the surgeon to determine that the cancer hasn’t spread. Mohs has the highest cure rate – up to 99% — for a skin cancer that hasn’t been treated before, and up to 94% for a skin cancer that recurs after previous treatment. Since more than 3 million Americans are diagnosed with skin cancer each year, it’s great to have such an effective treatment option to help so many of them.”

WHAT HAPPENS DURING MOHS SURGERY?

The doctors who perform Mohs surgeons must be highly trained, since they fulfill three roles during the procedure. They’re the surgeon who removes the cancerous tissue, the pathologist who analyzes the tissue under microscope, and the surgeon who repairs or reconstructs the resulting wound.

While the procedure is typically performed in a single visit, it can last several hours or longer. That’s because the Mohs process requires the patient to wait between each stage. During the wait, the doctor is determining whether cancer cells have remained after each microscopic layer of skin is removed. The process is repeated until no cancer cells are left.

Created by Dr. Frederic Mohs in the 1930s and advanced into its current form in the 1960s, Mohs surgery is done using local anesthetic, so patients experience little discomfort during the procedure. After the last layer of skin is removed and the doctor concludes no more cancer is present, the resulting wound can be repaired in several possible ways, depending on its size and depth. These include letting it heal on its own, closing it with stitches, using an adjacent flap of skin to cover it, or obtaining a skin graft from another body area to cover it.

Most of the time, Mohs surgery wounds heal beautifully and with little clue there was ever skin cancer present. Since as much healthy skin as possible has been retained, Mohs is the best technique for skin cancers developing in areas with only a little tissue beneath – such as the eyelid, bridge of the nose, ear, or top of the hand.

RISKS AND REWARDS OF MOHS SURGERY

Like every form of surgery, Mohs comes with certain risks – but these are minimal. They include bleeding, pain or tenderness around the surgical site, and infection. Other complications may include an enlarged scar, numbness or weakness surrounding the surgical area, or itching or shooting pain.

But the rewards of Mohs far outweigh the risks since the procedure offers the highest cure rate of any type of skin cancer surgery.

Mohs leaves the smallest possible scar for the largest possible peace of mind. While Mohs isn’t for every skin cancer patient, it’s useful for the vast majority. You can go home from Mohs surgery knowing your cancer is gone with little chance of it returning.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. www.advanceddermatologypc.com.

Richard Torbeck, MD, is a board-certified and fellowship-trained dermatologist specializing in Mohs micrographic surgery for skin cancer and cosmetic dermatology at Advanced Dermatology P.C.