Mohs Micrographic Surgery: The Most Accurate Way to Treat Skin Cancer

By Andrew P. Kontos, M.D., FAAD Board-Certified Dermatologist Fellowship-trained Mohs Micrographic Surgeon –

Mohs Micrographic SurgeryWhat is Mohs Micrographic Surgery (MMS)?
Mohs Micrographic Surgery (MMS) and the Mohs College were named after Dr. Frederic Mohs, the surgeon who pioneered the treatment 70 years ago and helped lead it to the state-of-the-art treatment it is today. Mohs Surgery is an outpatient procedure that involves the surgeon removing the visible skin tumor and diagramming the cancer site. If still positive, smaller and smaller sections of surrounding tissue are removed, which the surgeon immediately studies under a powerful microscope, until the surgeon determines that the all the cancer has been removed from the diagrammed area.

When is Mohs surgery performed?
Mohs Surgery is most commonly used for basal and squamous cell carcinomas. It should be the treatment of choice when: the cancer is large or aggressive; the edges of the cancer cannot be clearly defined; the cancer is in an area of the body where it is important to preserve healthy tissue for the maximum functional and cosmetic result (eyelid, nose, ears, lips, scalp, lower legs, fingers, toes, or genitals); the cancer is likely to recur if treated by other methods; prior treatment has failed.

How often is Mohs surgery successful?
The cure rate for Mohs surgery is as high as 99 percent for basal cell cancer (BCC), and 95 percent for squamous cell and recurrent cancers. Mohs Micrographic Surgery is a highly specialized and precise treatment for skin cancer in which the cancer is removed in stages, one tissue layer at a time. It is an outpatient procedure. The removal technique is no different than other procedures; however it is distinguished by a specific technique of tissue examination that is unique to Mohs surgery. Although some plastic surgeons and other specialists check excision margins, pathologic examination of the tissue is not the same as Mohs surgery.

I’ve heard that Mohs surgery will take all day and that I’ll be left with a huge hole in my face.
I usually will inform the patient to anticipate that the procedure will take the better part of a day. Most of the actual surgeries are brief, 20 minutes or less, so the largest portion of your day having Mohs Micrographic Surgery will be spent in the reception or designated waiting area as we process and examine the tissue we have removed. Because the Mohs procedure involves removing the entire tumor in one visit, and saving as much of the healthy surrounding tissue as possible, surgeons will remove a small piece of tissue, then immediately conduct pathology on the specimen. They will repeat this process several times, if necessary, until all the cancer is removed. While the process is time consuming, it ensures that the entire tumor is removed.
Other types of skin cancer surgery involve removing the tumor, closing the wound, and sending the tumor to a pathologist who will report several days later whether or not all the cancer was removed. If the tumor was not completely removed, a subsequent surgery at a later date would need to be scheduled. With the Mohs Micrographic Surgery procedure, the one-day process may take a little longer, but patients know immediately that all cancer was removed, which is very reassuring.

Will there be a scar from my Mohs Surgery?
Yes. Any treatment for skin cancer will leave a scar. Mohs surgery preserves as much normal skin as possible and maximizes options for repairing the area where the skin cancer had been. Once the Mohs surgeon has completely removed your skin cancer, optimizing the final cosmetic result of your surgery becomes our highest priority. Generally, a post-surgical scar improves with time and can take up to one year to be fully mature. If there are problems with the healing of your scar, injections or other treatments may be used to optimize the cosmetic result.

Will I need plastic surgery after Mohs surgery?
Mohs surgeons are highly trained in reconstruction, or repairing, the wound caused by removing the tumor, which makes the need for additional cosmetic surgery unnecessary in most cases. Advanced study and experience with the most current reconstruction techniques to minimize scarring is a major part of the fellowship-training that a Mohs College member must complete.

Do I need to continue to see my dermatologist if I go see a Mohs surgeon?
Yes. Your dermatologist is an important part of maintaining healthy, disease free skin on your entire body and you should visit the dermatologist on a regular basis. Following completion of your procedure, your Mohs surgeon will contact your dermatologist about your surgery and prognosis to make sure he or she is informed about your treatment.

Why is it called the “college” of Mohs surgery?
Professional medical associations use many different terms to describe their organization. Some examples are the American Medical Association, the American Academy of Dermatology, and the American College of Mohs Surgery. All are medical professional associations, but each has its own set of member eligibility requirements. In the case of the American College of Mohs Surgery, to be admitted, a member must have completed an approved fellowship in which they have participated in the surgery of at least 500 patients under the supervision of a trained instructor.

So the Mohs College isn’t a school?
Correct. The American College of Mohs Surgery is a membership organization committed to advancing the education, research, development and application of standards and guidelines to advance Mohs Micrographic Surgery. Part of ensuring that our members are highly trained is the advanced 1-2 year fellowship training they must complete before being admitted into the Mohs College.

Dr. Andrew Kontos is a board certified dermatologist and fellow-ship-trained Mohs surgeon, certified by the American College of Mohs Micrographic Surgery and Cutaneous Oncology. For more information on treatment options and other dermatologic concerns, call his office at 239-437-8810 at Riverchase Dermatology and Cosmetic Surgery at the Fort Myers location or 239-443-1500 for the Cape Coral location. You can also learn more by visiting www.RiverchaseDermatology.com.

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