Mohs Surgery

Mohs surgery, also known as Mohs micrographic surgery, is a highly effective and precise surgical technique used to treat skin cancer.

History and Development

Mohs surgery was developed by Dr. Frederic E. Mohs in the 1930s. The original technique involved using a zinc chloride paste to fix the tissue in place, allowing for the examination of the tumor's margins during the procedure. Over time, the technique has evolved and improved, with the introduction of frozen section pathology and other advancements.

Indications

Mohs surgery is primarily used to treat:

• Basal cell carcinoma (BCC), the most common type of skin cancer
• Squamous cell carcinoma (SCC), the second most common type of skin cancer
• Other rare types of skin cancer, such as Merkel cell carcinoma and dermatofibrosarcoma protuberans

Procedure

The Mohs surgery procedure involves the following steps:

1. The area around the tumor is numbed with a local anesthetic.
2. The visible portion of the tumor is removed, and a small margin of normal-appearing skin is taken.
3. The removed tissue is then frozen and cut into thin slices, which are stained and examined under a microscope by a pathologist.
4. If cancer cells are found at the margins of the removed tissue, the process is repeated, with additional layers of tissue being removed and examined until no cancer cells are detected.
5. Once the tumor has been completely removed, the wound is repaired, often using sutures, skin grafts, or allowing it to heal on its own.

Advantages

Mohs surgery offers several advantages over traditional surgical excision, including:

• High cure rates, with up to 99% success rate for primary BCC and SCC
• Precise removal of the tumor, minimizing damage to surrounding healthy tissue
• Maximal preservation of normal tissue and function
• Reduced risk of recurrence

Risks and Complications

As with any surgical procedure, Mohs surgery carries some risks and potential complications, including:

• Bleeding or hematoma
• Infection
• Scarring or wound healing problems
• Nerve damage or numbness

Recovery and Follow-up

After Mohs surgery, patients typically experience some discomfort, swelling, and bruising, which can be managed with pain medication and cold compresses. Follow-up appointments are usually scheduled to monitor the healing process and remove any sutures or staples.