Mohs Surgery: How Does it Work?

Mohs surgery is also known as Mohs micrographic surgery. It is used as a specialized procedure for the removal of skin cancer. Basal cell carcinoma and squamous cell carcinoma are two common cancers that physicians may opt to remove with Mohs surgery.  

What is Mohs Surgery and How Does it Work? 

Mohs surgery is a meticulous and precise procedure. It aims to remove as much cancerous tissue as possible, while also sparing the healthy surrounding skin. Mohs surgery is performed by a dermatologist and involves the steps listed below.  

  1. Local Anesthesia: The first step is to give the patient a local anesthetic. This will numb the surrounding area of the cancerous skin.  
  2. Initial Tissue Removal: The surgeon begins with removing the cancerous tumor or lesion, along with a very thin layer of the surrounding tissue. Generally, this initial excision is small and removed using a scalpel.   
  3. Tissue Mapping: This is a crucial step in the Mohs surgery process. It helps the surgeon precisely locate and identify remaining cancerous tissue. A detailed map or diagram tracks the exact location of the cancer cells found during the examination.  
  4. Tissue Examination: After the skin tissue is removed, it is placed on microscopic slides, stained, and examined by a professional. The surgeon examines the tissue to identify if there are cancer cells present at the edges of that tissue sample.  
  5. Iterative Process: If there are cancer cells detected within the tissue sample margins, then additional skin may need to be removed. The surgeon returns to the precise location on the map and removes an additional layer of tissue from that location. This iterative process is repeated until there are no remaining cancer cells observed.  
  6. Closure: There are a variety of options for closing the wound.  Depending on the size and location of the affected area, your physician will discuss and recommend different routes for closure. Sutures and grafts are some of the common methods of closure following a Mohs procedure.  

 Mohs Surgery Advantages:  

  • Immediate Evaluation: A tissue examination can often be completed on the same day, which serves as a major benefit of Mohs surgery. Follow-up and potentially additional excisions may be necessary if cancer cells appear. 
  • Preservation of Skin: A more obvious benefit involved with opting for Mohs surgery is the amount of healthy tissue this procedure can preserve. Other alternatives may include larger chunks of the skin being removed, resulting in more serious wounds and scars. Mohs surgery is an ideal choice for individuals who suffer from cancer in areas of the skin that are often exposed. The face is a common area for patients to opt for Mohs surgery for a more cosmetic and functional outcome.  
  • Precise Margins: As stated previously, Mohs surgery is very precise with each tissue margin being assessed. This advantage reduces the likelihood of the reoccurrence of cancer cells.  
  • High Cure Rate: The Mohs procedure is known for being successful and is one of the highest cure rates for skin cancer.  

Indications You Might Need Mohs Surgery: 

  • Type and Location of Skin Cancer: Mohs surgery is often recommended for skin cancers that are present in areas where preserving healthy tissue and minimizing scarring is critical. These areas include lips, fingers, genitalia, face, ears, nose, eyelids, and more. Other factors that contribute to the need for Mohs Surgery include the size and the severity of the cancer. A professional may recommend this procedure if the cancer is large or is aggressively growing. 
  • Uncertain Borders: If the border of the cancerous tissue is unclear, Mohs surgery may be necessary. This treatment option can be valuable in situations where the border of skin cancer is not visible due to the precise evaluation that this procedure offers.  
  • Cosmetic and Functional Concerns: As mentioned above, patients opt for Mohs surgery when cosmetic concerns are relevant. By preserving healthy tissue and minimizing tissue removal, it is often chosen where appearance is critical.  
  • Recurrent or Previously Treated Skin Cancer: Patients with recurrent or previously treated cancers are good candidates for Mohs surgery. 
  • Immunosuppressed Patients:  Patients with weakened immune systems may be susceptible to more aggressive cancers. To ensure thorough cancer removal, immunosuppressed patients may require Mohs surgery. 
  • High-Risk Skin Cancers: Aggressive cancers such as sasal cell carcinoma and squamous cell carcinoma are commonly deeply invasive. Therefore, Mohs curgery can provide the greatest chance of complete removal of the cancer. 

The decision to undergo Mohs surgery should be made after a comprehensive consultation with your physician. Dermatologists, who specialize in skin care, can provide personalized guidance catered to your individual history and case. Mohs surgery is considered the most effective technique for treating the two most common types of skin cancer today. 

Dr. Gurgen is double certified in Mohs Micrographic Surgery by the American Osteopathic Board of Dermatology and the American Society of Mohs Surgery. Dr. Gurgen performed thousands of Mohs surgeries during his time working exclusively as a Mohs Micrographic Surgeon before starting his practice. He is in the top 1% of all Mohs surgeons in the nation. 

If you are concerned about a skin abnormality, want to discuss your case, or simply need an annual skin checkup- contact our office for an appointment with Dr. Gurgen today!