Skin cancer is the most common cancer in the United States, affecting more people than breast, lung, colon and prostate cancer combined. With more than a million cases each year, 1 in 5 Americans will be diagnosed with skin cancer in their lifetime.
It is critical to take preventative measures to protect yourself from this disease. But for those diagnosed with skin cancer, there are options for treatment. Mohs surgery is an outpatient procedure that removes cancerous skin that is quickly processed and evaluated microscopically to ensure clear margins. It is considered the gold standard treatment for most skin cancers, including skin cancers of the head and neck.
Fredric Mohs developed the initial technique in the 1930s, which was then called chemosurgery. The Mohs surgical procedure was later refined in the 1970s and 1980s. Whereas previous surgical options removed a large area of skin and tissue around the cancer, Mohs surgery allows the dermatologist to remove cancerous cells while leaving as much healthy skin and tissue as possible.
One remarkable advance in skin cancer treatment that has occurred by using the Mohs technique is how the tissue is processed histologically. The tissue processing with Mohs surgery allows 100% evaluation of the true margin of the tissue. Traditional excision techniques allow for microscopic evaluation of a representative sample of only about 4% of the entire specimen. This has led to superior cure rates with Mohs micrographic surgery.
Mohs Surgery and the Treatment of Skin Cancers
Mohs surgery is considered the most effective treatment for most skin cancers, not just basal cell carcinomas and squamous cell carcinomas. For example, Mohs micrographic surgery is considered the gold standard for sebaceous carcinoma, dermatofibrosarcoma protuberans and microcystic adnexal carcinomas among several other less commonly diagnosed skin cancers. Mohs surgery is also being studied for its effectiveness in the treatment of certain early-stage melanomas as well as Merkel cell carcinomas, although it is not considered the standard of care at this time.
Mohs surgery only requires local anesthesia, so the patient does not need to be put under or even sedated. The dermatologist removes only the minimal amount of skin and tissue, which is then analyzed under the microscope to create a 360-degree map of the cancer. During the procedure, patients receive analysis. At the same time, they wait, ensuring that all the cancerous cells have been removed. In some cases, this process may require multiple rounds, which are performed during just one visit.
Because it is so precise, the cure rate for most skin cancers that have not been treated before utilizing the Mohs technique approaches 99%. Moh’s surgery is also up to 94% effective in treating skin cancer that has recurred after previous treatment.
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After the doctor has confirmed the removal of all cancerous cells, the area is reconstructed through stitching. In some cases, skin flaps or grafts are needed while some sites may even heal naturally. Reconstruction is done at the same time as the surgery itself with input from the patients. The surgery and reconstruction may sound invasive, but most patients are usually able to drive themselves home afterward — something that is not the case with more painful and aggressive procedures or those which require general anesthesia.
Mohs surgery is considered the gold standard for treating all skin cancers including basal cell carcinomas and squamous cell carcinomas. It is often used to address cosmetically and functionally significant areas on the face including lips, eyes and ears. It is also used to analyze and remove cancers on the fingers, scalp or genitals. Every patient is different, and you should discuss all treatment options with your doctor.
Editor's note: This article was originally published on November 4, 2015.