surgery is the most precise way to remove
skin cancers that are in either difficult
locations or have poorly defined borders.
Dr. Frederic Mohs invented the procedure
over 70 years ago. He discovered
that if he removed a skin cancer and
drew a precise map, that the skin cancer
could be tracked out more easily. This
process was originally carried out with
a fixative paste. In the 1970’s
the process was refined with the use
of frozen sections. This modification
dramatically speeds up the whole procedure.
the state of the art for Mohs surgery
involves the dermatologic surgeon acting
not only as the surgeon but also as
the pathologist and usually the reconstructive
surgery is designed to have the highest
cure rate, approaching 100%, for the
treatment of routine skin cancers such
as basal cell and squamous cell carcinoma.
It is also designed to conserve as much
normal tissue as possible. The more
normal tissue that is spared, the less
scarring results after the surgical
procedure is completed.
procedure itself involves numbing of
the skin around the tumor. A small margin
is excised around the obvious tumor.
The tissue that is removed is often
divided into one to four specimens.
The specimens are color-coded and then
processed. Processing involves freezing
the tissue and cutting thin specimens
that are placed on microscope slides.
These slides are then stained in a routine
fashion and examined microscopically.
The Mohs surgeon is able to precisely
determine if skin cancer is present
and where it is present.
the microscope slides are found to be
negative for skin cancer, then no further
surgery is necessary. However, if they
are positive for skin cancer then the
Mohs surgeon can go back precisely to
the area where there is residual skin
cancer and remove a little more. This
process is repeated until there is no
residual skin cancer left.
the Mohs surgical defects are repaired
following the Mohs surgical procedure.
These skin defects are either repaired
with a local flap (skin is moved into
the defect from adjacent normal skin)
or a skin graft is applied.
pain is usually minimal. Tylenol is
typically the only analgesic that is
patients get scars, the ultimate scar
is usually difficult to see and cosmetically