Mohs Micrographic Surgery is a specialized, highly effective technique used in the removal of certain types of skin cancer. It’s different from other skin cancer treatments because the entire examination and removal of the cancerous tissue are completed in one visit. It has the highest reported cure rate for basal cell carcinoma and squamous cell carcinoma, the two most common types of skin cancer. This procedure is performed by a specially-trained Mohs surgeon.
While some non-Mohs treatments may have satisfactory cure rates, certain subgroups are more difficult to treat with traditional methods. Your provider may refer you to Mohs depending on the type or location of the cancer, or if there is concern about recurrence or cosmetic outcome from another treatment. Mohs surgery may be indicated for tumors on the head and neck, including the scalp; or for large tumors on the trunk and extremities, recurrent tumors, or others whose pathology indicates they are aggressive.
Mohs surgery is a step-by-step process to remove skin cancer that can take up to several hours. First, the surgeon will mark the skin cancer site and numb the area with a local anesthetic. Then, the cancer will be removed surgically, including a small 1-2 mm margin surrounding the area. The removed tissue is then processed in our on-site Mohs lab and the surgeon examines it under a microscope (this takes about 45 minutes each time.) If the surgeon sees skin cancer cells on the margins of the tissue sample, he or she will remove more tissue in that area. The process is repeated, including tissue processing in the lab and examination under a microscope, until no skin cancer cells are detected.
Once all the skin cancer is removed, the surgeon will discuss closure and reconstruction options. Most often, sutures are placed the same day but, in some locations, and when large areas of tissue have been removed, the surgeon may discuss alternatives including reconstruction by plastic surgery.
Mohs surgery (and most resulting reconstruction) is completed in-office under local anesthesia. The procedure can take several hours, depending on the number of cancers removed, the size of the tumor, and how many layers are removed from each spot. On rare occasions, the surgery can take an entire day.
Patients will receive detailed pre- and post-operative instructions if they are scheduled for Mohs surgery. A person’s downtime and recovery following the procedure depends on a number of factors that will be discussed with you by the surgeon and staff.
Mohs surgery and resulting reconstruction are generally covered by insurance, but it’s a good idea to check with your insurance company to confirm your surgical coverage. The office will also obtain prior authorizations, or referrals for you prior to your visit, but individual reimbursement benefits are specific to your individual plan.