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basal cell carcinoma cosmetic reconstruction mohs surgery skin cancer reconstruction skin cancer treatment squamous cell carcinoma Nov 28, 2022

Mohs (pronounced like the food chain, Moe’s) micrographic surgery is considered the ‘gold standard’ in skin cancer treatment, but what is it anyway?

Perhaps you’ve heard the term, maybe you even know someone who’s had Mohs surgery, but do you really know what it is and why it’s done? Is it an acronym? If so, what does it stand for?

These are all great questions and something I answer daily as a Mohs surgeon! So let’s start at the beginning.

Mohs surgery is named for Dr. Frederic Mohs, a general surgeon at the University of Wisconsin who developed the technique of frozen tissue processing and skin marking for skin cancer removal in the 1930s. His technique has been refined and expanded upon over many decades to the now highly efficient, highly effective, and cosmetically beneficial technique that it is today. So no, Mohs is not an acronym, but the actual name of the doctor who developed the technique!

Mohs micrographic surgery is considered the ‘gold standard’ for skin cancer removal because it offers the highest cure rate for skin cancers at 99% for primary tumors and slightly less for recurrent lesions. No other treatment modality can compare! Mohs surgery is also highly beneficial for the treatment of skin cancers on the head and neck as often these are in cosmetically sensitive locations. With Mohs surgery, 100% of the margins are evaluated so the cure rate is higher and as Mohs surgeons, we don’t have to take such large margins. This is important on facial skin where you don’t want to remove any more ‘normal’ skin than you have to.

What does a typical day look like for a patient having Mohs surgery:

1. You arrive (typically in the morning) at your dermatologic surgeon's office. You can drive yourself unless you will be taking an anxiolytic.
2. You can eat breakfast and bring food as you won’t be put to sleep (no general anesthesia required).
3. You should take all your regular medicines that day unless instructed otherwise.
4. Plan to spend a few hours in your dermatologic surgeon's office: bring something to watch, read or listen to, bring extra food if you like, bring any medications needed during the day, wear something comfortable, and layers!
5. You will be numbed with local anesthesia much like when you had the biopsy. Then your Mohs surgeon will remove the skin lesion plus a safety margin around it. Your Mohs surgeon will ink and map the tissue for orientation purposes. You will be bandaged and then wait in the clinic room or in the waiting room.
6. Then comes the boring part…It typically takes 30-90 minutes to process the tissue in the lab and turn the tissue into a slide. (The lab is in your dermatologist’s office)
7. Your dermatologic surgeon will evaluate your slides and determine if the cancer has been sufficiently removed, or if an additional layer must be taken.
8. You will be brought back into a room for an additional layer if needed and steps 5 and onward will repeat until no more skin cancer remains.
9. Once the margins are clear (aka no more skin cancer), your dermatologic surgeon will then suture you up using a linear closure, flap, or skin graft. As Mohs surgeons, we perform hundreds of cases a year, tens of thousands in our lifetime so we are experts at these cosmetically sensitive closures. Sometimes we won’t close a wound and let it heal by ‘second intention.’ I like to call this ‘mother nature knows best’ healing!
10. Wound care will then be reviewed with you and you will head home to rest.

And that’s it! For many patients, this is a relatively quick and short day, especially for skin cancers that are caught early. For more challenging cases, it can be an all-day event. But for all patients when they leave the Mohs clinic, their skin cancer will have been completely removed and they are all stitched up.

Mohs surgery is a one stop shop for skin cancer removal where you have the same doctor removing the skin cancer, reading the pathology, and performing the reconstruction. It doesn’t get more efficient and cost effective than that!

And since a picture is worth a thousand words, watch this video showing how Mohs surgery is performed:

To find a fellowship trained and board certified Mohs surgery in your area, check out the American College of Mohs Surgery's link:

For more information on Mohs surgery, check out my podcast #17, ‘Welcome to Mohs with Dr. Mark Baucom’ for more information. Every Tuesday a new podcast is released!


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