Skin cancer is becoming more and more prevalent among Americans. According to the American Cancer Society, skin cancer is by far the most common type of cancer in the United States, accounting for approximately 5.4 million cases each year. The incidence of skin cancer has been on the rise for several decades, likely due to a combination of factors, including increased sun exposure, the popularity of tanning beds, and lifestyle changes that involve spending more time outdoors.

It’s essential to know your treatment options if you have been diagnosed with skin cancer. Mohs surgery, also known as Mohs micrographic surgery, is a highly specialized and advanced surgical technique commonly used to treat skin cancer. It is a highly effective procedure known for its ability to remove cancerous tissue while sparing healthy tissue. In this blog, we will explore how Mohs surgery works, what it is used for, its advantages over other treatments, and what patients can expect during the treatment.

Basics of Mohs Surgery

The Mohs technique was developed in the 1930s by Dr. Frederic Mohs, a general surgeon at the University of Wisconsin. Originally called chemosurgery, it was a painstaking process that could take days. Over the years, the procedure has been updated and refined to become the gold standard for treating skin cancer.

Mohs surgery is a highly specialized procedure used to treat different types of skin cancers, including basal cell carcinoma, squamous cell carcinoma, and some melanomas. It involves removing the cancerous tissue, layer by layer until all the cancer cells are removed while sparing as much of the surrounding healthy skin as possible. This also helps minimize scarring after the procedure. This is especially important since many skin cancers occur in areas of the face, such as the nose, lips, and ears.

Mohs surgery has the highest cure rate of any skin cancer treatment. Studies have shown that the cure rate for basal cell carcinoma with Mohs surgery is between 95% and 99%, and the cure rate for squamous cell carcinoma is between 94% and 99%.  

What Should You Expect During the Mohs Procedure?

Here’s a step-by-step overview of how Mohs surgery is performed:

1. Anesthesia: The area to be treated is first numbed with a local anesthetic to minimize pain during the procedure. Patients are awake during the procedure.

2. Tumor removal: The surgeon removes the visible tumor with a scalpel. The tumor is then divided into sections, and each section is labeled with a specific number or letter.

3. Mapping: The surgeon creates a map of the removed tissue, marking the location of each section with the corresponding number or letter. This allows the surgeon to track where each piece of tissue came from precisely.

4. Tissue examination: Each tissue section is then examined under a microscope to determine if it contains cancer cells. If cancer cells are found, the surgeon knows exactly where they are on the map.

5. Additional tissue removal: If cancer cells are found in a section, the surgeon removes another layer of tissue from that specific area. The process is repeated until no more cancer cells are found in any of the sections.

6. Wound closure: Once all the cancer cells have been removed, the surgeon may choose to close the wound using stitches or allow it to heal naturally. If the repair is more extensive, it may require a complicated procedure like a skin graft or flap.

7. Pathology: The tissue removed during the procedure is sent to a laboratory for final examination to confirm that all the cancer cells have been removed.

 A helpful diagram can be found at the following website:

When is Mohs Surgery Recommended?

It is mainly recommended for basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and some melanomas. When used for treating BCCs or SCCs, it’s best for skin cancers that are aggressive or large, for cancers in areas with little tissue beneath it (such as eyelids, nose, ear, genitals, hand, or foot), and lastly, for cancers that were treated and have now returned. It is also effective on some rare skin cancers, including extramammary Paget’s disease and Merkel cell carcinoma.

Who Should Perform My Skin Cancer Surgery?

Not all skin cancer requires Mohs surgery for treatment, but if Mohs is recommended, make sure the doctor is fellowship-trained at a recognized university or certified program. Fellowship training is additional specialized surgical training above and beyond a dermatology residency. It includes more specialized training in surgical skills, cutaneous oncology, dermatopathology, and facial plastic surgery, all of which is needed in skin cancer surgery. Two identifiers that a Mohs surgeon is Fellowship-Trained are:

1) They are a Fellow member of the American College of Mohs Surgery (ACMS), or

2) They are Board Certified by the Micrographic Dermatologic Surgery (MDS) board.

If you are faced with skin cancer requiring Mohs surgery, asking if the surgeon is fellowship-trained assures they have been trained to those standards. At Vitalogy Skincare, we know first-hand how necessary the early treatment of skin cancers is. If you would like to come in for an examination or skin cancer treatment, our Fellowship-Trained Mohs Surgeons and Board-Certified Dermatologists are here to help. Our Providers are highly trained and have years of experience treating all kinds of skin cancers. We aim to provide the best possible outcomes for you in a caring environment. Please make an appointment at any of our locations in Bastrop, Burnet, Cedar Park, Georgetown, Harker Heights, Marble Falls, San Marcos, and Southwest Austin.