Skin cancer is the most common form of human cancer, but it is also typically curable when caught early. Different types of skin cancer, including the most common skin cancers such as basal cell carcinoma and squamous cell carcinoma, require different types of treatments, and one option that may be the best choice in certain situations is Mohs surgery.
Mohs surgery is a specialized type of skin cancer surgery performed by dermatologists. Dr. Rodgers of Rodgers Dermatology is a certified Mohs surgeon and performs the procedure in our office. This post will answer common questions and explain how the surgery works.
Understanding Mohs Micrographic Surgery
Mohs micrographic surgery is a highly specialized technique used to treat skin cancer. This precise surgical procedure involves removing thin layers of skin, one at a time, and examining each layer under a microscope to determine if any cancer remains. The process continues meticulously until only cancer-free tissue remains. Mohs surgery is considered the gold standard for treating high-risk skin cancers, particularly in cosmetically and functionally critical areas such as the face, scalp, ears, hands, feet, and genital areas. This method ensures that the maximum amount of healthy tissue is preserved while effectively eliminating the cancerous cells.
Types of Skin Cancer Treated with Mohs Surgery
Mohs surgery is primarily used to treat two types of skin cancer: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCC is the most common form of skin cancer, accounting for approximately 80% of all skin cancer cases. It typically grows slowly and rarely spreads to other parts of the body. On the other hand, SCC is the second most common form of skin cancer and is more aggressive than BCC, with a higher likelihood of spreading. Mohs surgery is also effective in treating other types of skin cancer, including certain melanomas, dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, sebaceous carcinoma, and extramammary Paget disease. This versatility makes Mohs surgery a valuable option for various skin cancer diagnoses.
Benefits of Mohs Surgery for Skin Cancer
Mohs surgery offers several significant benefits for treating skin cancer. One of the primary advantages is its high cure rate, with a success rate of up to 99% for certain types of skin cancer. This high efficacy is due to the meticulous process of removing and examining each layer of tissue until no cancerous cells remain. Another key benefit is that Mohs surgery removes only cancerous tissue, sparing healthy surrounding tissue and minimizing scarring. This tissue-sparing approach is particularly beneficial for cancers located in visible or functionally critical areas. Mohs surgery is typically performed outpatient, allowing patients to return home the same day. Using a local anesthetic ensures that the patient remains comfortable throughout the procedure, making it a convenient and effective option for treating skin cancer.
What Happens During Mohs Micrographic Surgery
During the Mohs procedure, Dr. Rodgers removes the visible portion of the skin cancer, along with a narrow margin of surrounding healthy skin. The tissue goes to an on-site lab, where it is processed, stained, and evaluated under the microscope by Dr. Rodgers.
He thoroughly examines the entire underside and edges of the tissue to ensure no remaining skin cancer cells are present. If cancer is still present, he goes back into surgery and removes another layer of tissue, but only at the exact site that was noted to be “positive” under the microscope. This allows him to preserve any normal, non-involved skin. Once the skin cancer is entirely gone, he repairs the surgical defect. Other specialists, including plastic surgery or ENT surgeons, will sometimes be involved in the repair.
When is Mohs Surgery Necessary for Treating Skin Cancer?
Not all skin cancers require Mohs surgery. Dr. Rodgers will determine if you are a candidate and if your skin cancer requires this procedure. Mohs surgery is typically used for skin cancers in anatomic areas where preservation of normal healthy tissue is critical for functional and/or cosmetic purposes. This might include the face, neck, eyelids, nose, ears, fingers, and toes. Mohs surgery may also be used for skin cancers that have recurred after previous treatment, large skin cancers, and other situations. Studies have shown Mohs surgery to provide a five-year cure rate of 99% for new cancers.
Here’s a look at Mohs surgery for the three most common types of skin cancers, according to the American Society for MOHS Surgery:
- Basal cell carcinomas — Mohs surgery has the highest success rate of removing all basal cell growth. Dr. Rodgers removes the basal cell cancer layer by layer. After removing a layer, he examines it immediately to check for any remaining cancer cells on the borders. If cancer cells are still present, he goes back into surgery at that time to remove another layer or ring. He continues this process until the sample is clean under the microscope. This is especially effective for removing growths on the face, as only the minimum amount of tissue is removed.
- Squamous cell carcinomas—Mohs surgery has the highest success rate of removing all squamous cell carcinomas. The process is similar to the one described above. It involves Dr. Rodgers removing the squamous cell cancer layer by layer or ring by ring around the growth and immediately examining it to check for any remaining cancer cells on the borders. He continues this until he finds no more cancer cells. Mohs is also an effective option for removing growths on the lips since the minimum amount of tissue is removed.
- Melanoma—Mohs surgery is effective for removing melanoma that has been diagnosed but hasn’t spread. It involves removing the melanoma and a surrounding ring of tissue. This outer ring is instantly examined under a microscope to see if cancer cells are still present. If they are, another ring of tissue is immediately removed and examined. This process is repeated until the tissue is free of cancer cells.
Reconstruction After Mohs Surgery
Mohs surgery is typically very effective in removing all cancer cells and curing skin cancer. While this is our top priority, many patients are often concerned about scarring and other lasting effects of the surgery. Reconstruction after Mohs surgery is often necessary to address significant facial wounds. All surgical procedures have the potential for some degree of visible scarring.
The appearance of a post-Mohs surgical scar will depend on several factors, including the size and location of the final defect, individual skin characteristics, and the reconstructive surgery options available. However, because of the tissue-sparing nature of the Mohs technique, you may have a smaller, less noticeable scar than with other skin cancer removal methods. Most scars improve in appearance naturally over time, and there is the possibility of future scar revision, if necessary.
Despite the concern about scarring, we always recommend having skin cancer removed by a dermatologist with specialized training in Mohs surgery due to the histopathology component of the procedure.
Dr. Rodgers has extensive training in Mohs surgery. Residency training provides the basic skill set for the Mohs technique, including skin cancer pathology, dermatopathology, dermatologic surgery, the repair of surgical defects, and training under other Mohs surgeons. After residency, Dr. Rodgers underwent further training through the American Society for Mohs Surgery.
*If you have been diagnosed with skin cancer for which Mohs surgery is indicated, we would be happy to discuss the procedure with you in further detail. Call 972-704-2400 or book your appointment online to schedule a consultation with us to discuss Mohs surgery or other procedures and skin cancer prevention.