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What is Mohs Micrographic Surgery?
Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer. The procedure was developed in the 1930's by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all "roots" and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate: 99% (up to 95% for recurrent skin cancers).
What are the advantages of the Mohs Procedure?
Some skin cancers can be deceptively large - far more extensive under the skin than they appear to be from the surface. These cancers may have "roots" in the skin, or along blood vessels, nerves, or cartilage. Skin cancers that have recurred following previous treatment may send out extensions deep under the scar tissue that have formed at the site. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous "roots." For this reason, prior to Mohs surgery it is impossible to predict precisely how much skin will have to be removed. The final surgical defect could only be slightly larger than the initial skin cancer, but occasionally the removal of the deep "roots" of a skin cancer results in a sizeable defect. The patient should bear in mind, however, that Mohs surgery removes only the cancerous tissue, while the normal tissue is spared.
When should Mohs surgery be considered?
It is important to note that Moh's surgery is not appropriate for the treatment of all skin cancers. Mohs micrographic surgery is typically reserved for those skin cancers that have recurred following previous treatment of cancers that are aggressive, poorly defined, or are at high risk for recurrence. Mohs surgery also is prescribed for cancers located in areas such as the nose, ears, eyelids, lips, hairline, hands, feet, and genitals, in which maximal preservation of healthy tissue is critical for cosmetic or functional purposes.
How long does the procedure take?
Typically, Mohs surgery is performed as an outpatient procedure in the physician's office. Most Mohs cases can be completed in three or fewer stages, requiring less than four hours. However, it is not possible to predict how extensive a cancer will be, as the extent of a skin cancer's "roots" cannot be estimated in advance. Therefore, it is advisable to reserve the entire day for this surgical procedure, in case the removal of additional layers is required.
Is the procedure painful?
Although the patient is awake during the entire procedure, discomfort is usually minimal and no greater than it would be for more routine skin cancer surgeries. Most patients do not complain of significant pain. If there is some discomfort, normally only Tylenol is required for relief. However, stronger pain medications are available and will be prescribed when needed. You may experience some bruising and swelling around the wound, especially if surgery is performed near the eye area.
What are my reconstruction options after the surgery?
After the skin has been removed, your surgeon will discuss the following options with you:
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Allowing the wound to heal naturally, without the necessity of additional surgery (which may produce the best cosmetic result).
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Simple or complex wound repair performed by your surgeon with the use of other cosmetic procedures.
How can I find out more about Mohs Surgery?
You can visit the American Society for Mohs Surgery website at | 
