Skin cancer is the most common form of human cancer, but it is also typically curable when caught early. Different types of skin cancer require different types of treatments, and one option that may be the best choice is certain situations is Mohs surgery.
Mohs surgery is a specialized type of skin cancer surgery that is performed by dermatologists. Dr. Rodgers of Rodgers Dermatology is a certified Mohs surgeon and performs the procedure in our office. In this post, we will answer common questions and explain more about how the surgery works.
What Happens During Mohs Surgery
During Mohs surgery, 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 examines the entire underside and edges of the tissue thoroughly to ensure there are no remaining skin cancer cells. 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. In some cases, other specialists will be involved in the repair, including plastic surgery, or ENT surgeons.
When is Mohs Surgery Necessary?
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 on the body, and in some 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 a layer is removed, 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 of the squamous cell carcinoma as well. The process is similar to the one described above that 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. Mohs surgery involves removing the melanoma and a surrounding ring of tissue. This outer ring is instantly examined under a microscope to see if there are cancer cells still present. If there are, another ring of tissue is immediately removed and examined. This process is repeated until the tissue is free of cancer cells.
After Mohs Surgery
Mohs surgery is typically very effective in removing all cancer cells and providing a cure for skin cancer. While this is our top priority, many patients are often concerned about scarring and other lasting effects of the surgery. 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 size and location of the final defect, individual skin characteristics, and the reconstruction 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.