If you’ve been diagnosed with skin cancer you might be worried about how it can be treated and whether you’ll have noticeable scarring. Often, skin cancer can be removed with topical chemotherapy creams or simple surgical procedures. Those skin cancer treatments work fine for many types of skin cancer, especially when the lesions are small, or are on less visible areas on the arms, legs or trunk where a scar might be less apparent.
But sometimes, a procedure called Mohs surgery is a better choice. Mohs surgery, named after the doctor who pioneered the technique in 1936, is a specialized, layer-by-layer skin cancer removal technique. With it, a surgeon removes the skin cancer lesion with narrow margins. “Usually, one to two millimeters are all that’s required to start,” said Joshua Tournas, MD, a dermatologic surgeon who specializes in Mohs surgery at Banner Health Clinic in Sun City, AZ. Mohs surgery is highly accurate—on average, it has a 99 percent cure rate.
What type of skin cancer can you treat with Mohs surgery?
Surgeons typically choose Mohs surgery for basal cell carcinoma and squamous cell carcinomas, especially when they are on the head or neck or when they are bigger or more aggressive. “There’s a growing body of evidence that Mohs surgery can be used for early-stage melanoma of the head and neck as well,” Dr. Tournas said.
Mohs surgeons might collaborate with other surgeons on complex cases, such as tumors on the margin of the eyelid, where every millimeter counts.
What’s the Mohs surgery process like?
Mohs surgery is an all-in-one appointment in your doctor’s office. You come in early in the morning to check-in, complete paperwork and have your vital signs checked.
When it’s time to start the procedure, your doctor will inject a local anesthetic and remove the tumor plus a tiny margin of healthy skin around it. “We start narrowly around the tumor and only make it bigger if we have to. We want to get the smallest possible wound for the given amount of skin cancer you have,” Dr. Tournas said.
After the tumor is removed, the surgeon sends it to a technician who freezes it, cuts it into thin horizontal slices and prepares it for evaluation. Your Mohs surgeon then examines the sections of the tumor under a microscope. “We cut and prepare the sample to get a 100%view of the edges and the base,” Dr. Tournas said. You’ll need to wait 30 to 60 minutes while the technician processes the sample and the surgeon evaluates it.
If cancer cells remain, your doctor can remove a bit more tissue from the exact spot shown by the sample without needing to remove any additional healthy tissue than necessary. On average, it takes 1.6 tries to remove a tumor completely. So, it’s likely your surgeon will complete the procedure in one to two attempts.
Once your tumor is entirely removed, your surgeon will repair the surgical site. Depending on the site and its size, you might need the wound sutures in a straight line, or perhaps a skin graft. Occasionally, your wound can even heal on its own.
“With Mohs surgery, the same doctor is hitting all the touchpoints—you see the cancer in the person and under the microscope and follow it from beginning to end,” Dr. Tournas said.
Most people spend about a half-day completing Mohs surgery. “When you leave that day, you know with 99 percent certainty that your cancer is not going to come back,” Dr. Tournas said. With traditional surgery, once your tumor is removed, you must wait three to seven days to find out whether it was entirely successful.
Because Mohs surgery is performed under local anesthetic, you avoid the cost and complexity of general anesthesia. Plus, Mohs surgery is an option for people who aren’t healthy enough to undergo general anesthesia.
How can you find a surgeon who performs Mohs surgery?
Your dermatologist can probably recommend a surgeon. If you need to find someone on your own or you would like to check credentials, ask if they are fellowship-trained in Mohs surgery or procedural dermatology and if they are a member of the American College of Mohs Surgery, Dr. Tournas said. “That’s the best way to make sure that your Mohs surgeon has done the extra training necessary after dermatology residency to become an expert in the field.”
The bottom line
For certain common types of skin cancer, Mohs surgery can remove the tumor, keep your body functioning properly and preserve the appearance of your skin. If you would like to connect with a dermatologist to evaluate your skin, reach out to Banner Health.
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