Mohs (Micrographic Surgery)

Mohs surgery is an incredibly effective surgical technique for the removal of skin cancer. Using a microscope to view the tumor in stages has been proven to better ensure that the cancerous tumor and its roots are completely removed. The method is most often used in the treatment of basal cell carcinomas and squamous cell carcinomas, the two most common types of skin cancer.

Advantages of the technique are that by removing only affected cancerous cells, as much healthy tissue as possible is preserved and cure rates are between 96%-99%. The disadvantages of the technique are that it’s expensive and time-consuming compared with standard surgical excision.

When is Mohs (Micrographic Surgery) Used?

Mohs may be used when treating individuals that have recurring skin cancers, or cancers that are at a high risk for recurrence. Mohs might also be conducted if the cancer is found in an area where function and cosmetic appearance are important, particularly areas of the face such as the lips, ears, eyelids and nose.

How is Mohs Surgery Conducted?

Mohs surgery is an outpatient surgery that can typically be completed in three or fewer stages, usually requiring less than four hours.

First, the dermatologic surgeon marks the tumor margins with a surgical marker. Local anesthesia is then administered. Next, first-level incisions are made, and a first layer of tissue is removed for analysis. During histological examination, the specimen is frozen, and gel is applied to hold the tissue in place. The surgeon then divides the specimen into thin sections for microscopic examination. If cancerous cells are found, additional layers of tissue are removed and examined until no cancer is found.

Finally, the wound is cauterized to stop bleeding, and is then sutured and bandaged. Some wounds may require a graft or flap.

Recovery From Mohs Surgery

A Mohs surgery patient may require anywhere from one to 10 or more levels of Mohs to clear a tumor. Generally, the more levels a patient must go through, the longer the recovery time. With more aggressive tumors, or tumors in high-risk areas, regular follow-up appointments are required.

The patient’s dermatologic surgeon will provide them with detailed instructions on how to care for their wounds following Mohs surgery. Again, recovery time depends on the conditions:

• Location of the surgery
• Extent of the removal
• Size of the defect prior to closure
• Amount of tension and type of closure

Follow-up examinations are critical for any cancer patient. Monthly self-examinations are encouraged, and a physician should check any changing or new growth.

Please call us at 425-391-2500 if you would like to make an appointment with Seattle Mohs surgeon Dr. Victor Michalak to learn more about Mohs (micrographic surgery).