Mohs Micrographic Surgery

To understand Mohs surgery, a type of surgical dermatology, it is important to first understand how cancerous lesions develop in the skin.While there are many factors that can cause cells to divide rapidly and unchecked—including genetics and environmental pollution—the most common is sun damage. This can be especially intense sun damage, which causes serious burns,as well as cumulative sun damage which builds up over time—often decades.

Ultraviolet radiation damages skin cells, which can then begin to grow in unhealthy ways. This mutated growth leads to the development of lesions that can appear as spots or bumps. While the problem is visible at the surface, it typically extends downward into the skin as well.

This is why Mohs surgery comes in. The surgical strategy focuses on removing all traces of the cancerous cells from an identified lesion, from top to “roots.” This method was first developed in the 1930s by Dr. Frederic Mohs, who was working at the University of Wisconsin.

A Mohs micrographic surgery session involves removing a layer of cells, which are then examined right away. Anywhere cancerous cells—referred to as malignant cells, as opposed to healthy or benign cells—are spotted in the tissue indicates that the problem extends farther. The next layer of tissue will then be removed and examined in the same way.

Each time cancerous cells are identified, a new layer will be taken—but only from where the cancer is detected. This real-time treatment strategy accomplishes two things: First, it allows for incredible precision, since the physician can literally “follow” the cancerous lesion to its roots and remove all malignant cells. Second, it avoids removing tissue unnecessarily, which keeps the resulting wound as small and unobtrusive as possible.

The precision gives Mohs surgery a cure rate of higher than 90 percent.

Mohs surgery is highly effective, but not appropriate for every type of skin cancer. The surgical strategy is most appropriate for slower-growing lesions, such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs surgery can also be used for melanoma—the most serious form of skin cancer—and additionally sebaceous cell carcinoma. This is best discussed in consultation with Dr.Carroll.

The thoroughness possible with Mohs surgery makes it ideal for treating cancers that have a high chance of recurrence, as well as those that have recurred after a prior treatment attempt.

This strategy’s precision and maximum tissue preservation also make it a popular choice for patients with cancerous lesions in delicate, sensitive, or highly visible areas. Common areas of focus are the face (nose, eyelids, lips) head (hairline,ears), hands, feet, and genitals. It also preserves vital structures and provides for the best cosmetic outcome.

Prior to Mohs surgery, patients will be advised to set aside a day for the procedure. Although it is accomplished in real time over a single session, there is no way to predict exactly how long a treatment will take. Be sure to arrive with clean skin free of makeup, sunscreen, and skincare products. We also suggest wearing (or at least bringing) warm clothing in case you get chilly, as well as having something on hand to keep you entertained while you wait. A book to read or device for watching a show or movie is a good choice.

Mohs surgery itself involves marking the visible margins of the lesion to start. Next, a local anesthetic will be injected in order to reduce sensation in the treatment area. Then, the tissue removal begins. After each layer, the patient will be given a bandage and will wait as the tissue is minutely examined.

The examination process creates what is known as a “Mohs map,” which guides Dr. Carroll in which direction to next remove tissue.

Once all of a lesion’s margins are “clear”—which means no malignant cells have been detected in any sample—the cancer is considered to have been completely removed.

Patients will then discuss wound healing with Dr. Carroll, with details depending on the location, size, and depth of the wound.

Excision is a common strategy for removing unwanted lesions from the skin, but no approach is as thorough and meticulous as Mohs micrographic surgery. That said, not all lesions require the Mohs approach.Benign moles and other lesions may be simply shaved down, or may be surgically excised with stitches. Atypical moles, which look different from the rest of a person’s moles, carry a higher risk of developing melanoma and should be removed and biopsied. This is a different process from Mohs surgery, but can still be an effective way to treat and minimize risk of skin cancer. Warts, which are growths caused by viruses, may be frozen, cut out, or treated with medication.

Some patients benefit from dermoscopy, which involves closely examining the skin’s surface and any pigmented lesions in order to determine is excision or a biopsy is needed.

Patients whose concerns are primarily aesthetic—such as those who want to address unwanted spots—can also ask about our cosmetic dermatology options. Laser treatments can fade “age” or “sun” spots, helping the skin to look clearer and more youthful. Resurfacing is another strategy for reducing or removing imperfections that develop over time do to sun exposure, environmental damage, and the natural effects of aging.

There are numerous techniques available for removing growths and lesions of various origin and size—but it is important to always first get an accurate diagnosis. A consultation and skin check represent a good first step, as well as an opportunity for patients to share their concerns, medical history, and goals with the Carroll Dermatology team. We want you to be happy and healthy for years to come, so we work hard to apply our experience and skill to every condition we come across.