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Mohs Surgery, also known as chemosurgery, is a procedure designed to excise entire lesions of skin cancer utilizing frozen section histology. It is most effective in removing primary basal cell carcinomas, but is also used for removing squamous cell carcinoma and melanoma-in-situ.

The procedure was developed by Fredrick Mohs, initially using a paste applied to the fresh wound of partially removed skin cancer and allowing it to dry overnight. This thin slice of tissue would become anesthetized, removed and observed under a microscope. If any cancer remained, the paste would be reapplied and the patient would return the next day until no cancer remained.

As technology and medicine have improved, the thin slices of tissue can be anesthetized and removed consecutively; once the previous slice has been observed and all cancerous findings mapped, the next piece is removed immediately, allowing the procedure to last less than a day. 

The most significant advantage to Mohs Surgery is its extremely high success rate. Studies have shown that primary basal cell carcinoma removal has a 97-99% cure rate, while squamous cell carcinoma is considered to be successful approximately 94% of the time. Melanoma-in-situ removal success ranges from 75-95%, depending heavily on the skill of the surgeon.

Mohs surgery is often performed by four different specialists: dermatologic surgeon, histotechnician, pathologist, and reconstructive surgeon. The dermatologist is responsible for removal of the slides, while the histotechnician prepares them for microscopic use by flattening and mounting them. The pathologist observes and closely maps the locations of the cancer in the slide and lets the dermatologist know when the cancer has been completely removed. The reconstructive surgeon is responsible for closing the wound with special cosmetic proficiency.

Although one well trained doctor could handle all of these positions simultaneously, it is most common for the pathologist position to be filled by an individual with extreme expertise in both the disease and microscopy. It is also possible for a full team of four or more specialists to perform the operation. No matter how the work is divvied up, communication and smooth transition through each phase should be perfected to ensure the most efficient procedure possible.

Unfortunately, all surgical procedures carry the risk of scarring, and Mohs surgery is no different. However, the dermatologist performing Mohs surgery can utilize multiple methods to further prevent visible scarring to the affected area. The most common approach is for the surgeon to simply integrate stitching into natural skin crevices or out-of-sight areas, such as underneath the jaw line. This can be embellished using a “skin-flap” to shift the unsightly skin into one of these hidden places. Another less common practice is to allow a specialized plastic/reconstructive surgeon to perform the closure, normally at the behest of the patient.

It is important to note that the size and location of the tumor heavily influence scarring potential. The procedure itself is designed to minimize tissue excised due to the small surgical margin of one millimeter, therefore naturally leading to less scarring.

If you are interested in learning more about our Mohs Surgery procedures, call 302-633-7550 today to schedule an appointment.