Mohs Micrographic Surgery for Skin Cancer

Mohs surgery is a highly specialized surgical procedure where thin layers of tissue are removed layer by layer and examined under a microscope until all of the cancer is eliminated.  This microscopic technique gets to the “root” of the cancer and eradicates it while preserving as much healthy tissue as possible. This minimizes the size of the surgical defect and produces a much smaller scar. Surgery is complete when the last layer is deemed cancer-free. Reconstruction of the surgical defect occurs immediately.

Standard excision usually requires the removal of large margins of healthy tissue to assure no cancer cells are left behind. The surgeon will not know if she removed all the cancer until the pathologist sends back their report. If cancer remains, the patient must return for more surgery and reconstruction cannot be done until all the cancer cells are removed. Even with “clear margins” as assessed by the pathologist, the cure rate with standard excision is 94-95% (approximately 1 in 20 will recur) compared to 99.9% cure with Mohs Micrographic Surgery.

Mohs surgery is performed by a specialty trained team that includes Dr. Zeena, several surgical assistants, and a technician who prepares the tissue for microscopic examination. You will meet the entire team at the time of your consultation and/or surgery.

Dr. Zeena is a fellowship-trained Mohs surgeon with extensive training in post-Mohs reconstruction. She is not only the surgeon; she is also the pathologist examining 100% of the tissue margins to ensure clearance of the cancer while minimizing the sacrifice of normal skin; and a cosmetic surgeon who performs the reconstruction.

Mohs surgery is indicated to treat skin cancer on the face, eyelids, nose, and ears; for cancers in areas of limited mobility such as the fingers, hands, feet, and toes; and the genitalia where standard surgical excision would cause disfigurement. It is also the best choice treatment for recurrent skin cancers, cancer that grows in scar tissue, large cancerous tumors and tumors with borders are not well defined; for aggressive and infiltrating skin cancers; and for skin cancers with unusual growth patterns.

1. The surgeon marks the lesion to create a map of the cancer. The skin is numbed with a local anesthetic and the surgeon begins by removing a thin layer of skin.
2. Each tissue sample is mapped and color-coded to reflect the exact location where it was removed from the body.
3. The laboratory staff freezes the tissue, sections it into paper thin slices that are placed onto glass slides and stained in the Mohs lab.
4. The slides are examined by Dr. Zeena to determine if any tumor cells are left behind. When the tumor is removed completely, the skin defect is ready to be repaired. If the specimen has residual tumor, steps 1 through 4 are repeated until the skin is clear of tumor.

Because the tissue is removed in multiple stages patients are advised that the procedure may last 2 – 4 hours, and in rare instances longer. Mohs surgery provides the most cosmetically acceptable results and the highest cure rate available. Speak with Dr. Zeena about Mohs surgery and your options.