Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer.
Research has shown that Mohs surgery is the skin cancer treatment with the highest reported cure rate. Mohs surgery is most commonly used to treat basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), but also has been demonstrated as an excellent choice for many other types of less common skin cancers.
The procedure was developed in the 1930s by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all “roots” and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.
Special Qualifications of the Mohs Surgeon
Click this link to learn more information about the American College of Mohs Surgery and why fellowship training is so important.
FFMS physicians performing Mohs surgery have specialized skills in Mohs surgery and surgical reconstruction. All FFMS Mohs Surgeons have completed intensive training in one or two year fellowship programs under the auspices of the American College of Mohs Surgery, the only fellowship-training institution for Mohs Surgery overseen by the Accreditation Council on Graduate Medical Education (ACGME). This specialized, advanced training involves focusing on Mohs Surgery and surgical reconstruction of the wounds after the cancer has been removed, working closely with a mentor. In addition, the Mohs surgeon must have the required surgical and laboratory facilities.
Advantages of the Mohs Surgical Procedure
Some skin cancers can be deceptively large – far more extensive under the skin than they appear to be from the surface. These cancers may have “roots” in the skin, travel along blood vessels or nerves, or even invade cartilage or bone. Skin cancers that have recurred following previous treatment may send out extensions deep under the scar tissue that has formed at the site. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous “roots.” For this reason, prior to Mohs surgery it is impossible to predict precisely how much skin will have to be removed. The final surgical defect could be only slightly larger than the initial skin cancer, but occasionally the removal of the deep “roots” of a skin cancer results in a sizeable defect. The patient should bear in mind, however, that Mohs surgery removes only the cancerous tissue, while the normal tissue is spared.
Special Indications for Mohs Surgery
Mohs micrographic surgery typically is reserved for those skin cancers located in areas such as the head and neck, hands, feet, and genitals, in which maximal preservation of healthy tissue is critical for cosmetic and/or functional purposes. Mohs surgery also is indicated for cancers that have recurred following previous treatment, large skin cancer, or for cancers that are at high risk for recurrence.
It is important to note that Mohs surgery is not appropriate for the treatment of all skin cancers. The FFMS supports the Appropriate Use Criteria (AUC) for determining when Mohs Surgery may be indicated.
Patient Preparation for Surgery
You should provide your physician with a complete list of all medications (prescription, over-the-counter, vitamins, and supplements). Some patients should take antibiotics just prior to surgery. Your doctor may have other preoperative instructions, so please ask. Additionally, Mohs surgery on some areas may impair your ability to safely operate a motor vehicle. Discuss this with your doctor or his/her representative before your surgery.
The American College of Mohs Surgery also maintain a Patient's Website that is an excellent source of material.
Options for Post-Surgical Reconstruction
Your FFMS Mohs Surgeon has advanced training and experience in reconstruction of surgical wounds after the skin cancer has been removed. Fellowship-training through the American College of Mohs Surgery ensures your surgeon has the knowledge and skill to maximize your cosmetic outcome.
There are various options that may also include:
Allowing the wound to heal without any additional surgical repair.
Repair by the original referring physician.
Repair by another surgeon who might have a particular expertise regarding an anatomic area, repair type, special equipment, or skill regarding repair of inordinately large defects.
If your wound requires daily care at home, you will be given instructions following your surgery.
Insurance Coverage for Mohs Surgery
Most insurance policies cover the costs of Mohs surgery and the reconstruction of the resultant surgical defect (less co-payments and deductibles). Please contact the billing department of your Mohs surgeon’s office if you have questions about insurance coverage or to see if your insurer requires you to have a referral from your primary care physician. You may need to contact your insurance company directly about benefits or coverage.