If you or someone you love has recently been diagnosed with skin cancer, knowing the most effective treatment options available is important to the recovery journey. Mohs surgery is a specialized surgery with the highest cure rates for various types of skin cancers. Expertly trained Mohs surgeons perform the treatment to give patients exceptional, immediate outcomes with minimal scarring.
Schedule a consultation at Berman Skin Institute today.
What Is Mohs Surgery for Skin Cancer?
Mohs micrographic surgery (MMS) involves your Mohs surgeon carefully removing cancerous tissue using local anesthesia while preserving as much healthy skin as possible. The method has gained immense popularity since its invention in the 1930s and is now the gold standard for treating several types of skin cancer.
The Procedure: What to Expect During Mohs Surgery
Your Mohs surgeon will remove small skin sections at a time, analyze them under a microscope and close the wound only when finding no evidence of remaining cancer cells. When undergoing Mohs surgery, you’ll go through one or several rounds of skin removal, depending on how deeply rooted the cancer is. Explore each step of this procedure below.
1. Removing the Abnormal Skin Layer
You’ll be awake during the Mohs procedure, and your surgeon will numb the affected area with an injectable anesthetic. Before incisions, they will sterilize the skin and carefully mark it so that only the essential tissue is removed to minimize stitching and potential scars.
Your Mohs surgeon will cut away the patch of cancerous tissue, taking note of the layer’s orientation relative to the surgical site. Orientation is important so that if cancer cells are found on the tissue’s margins during microscopic examination, the surgeon will know exactly where to cut away more skin without compromising healthy tissue.
After skin removal, your Mohs surgeon will place a bandage on the surgical site, and you’ll be taken to a comfortable waiting area.
2. Processing the Tissue Onto Slides
While you wait, the laboratory will process the tissue on-site. A technician who specializes in dermatopathology creates a Mohs map to record various details of the skin sample. Then, very thin slices of the sample are collected and dyed so skin cells are visible under a microscope. Cancer cells react differently to the dye, so your Mohs surgeon can tell which cells are healthy and which need to be removed based on color or saturation differences.
3. Reviewing the Samples for Cancer Cells
The thin, flat layers represent horizontal cross-sections of your cancerous lesion. Depending on how advanced your cancer is, different steps will occur:
- No cancerous cells on the sample margins: If the microscopic evaluation shows that no abnormal cells are touching the perimeter of the sample, the surgeon will know that they’ve removed the entire tumor. Your Mohs surgeon will close up your wound using sutures if required. Some smaller removal sites can be left to heal on their own.
- Cancerous cells are present on the margins: If any of the the sample layers show cancerous cells along their margins, this means the cancer has spread wider than what was excised, and a second round of Mohs surgery is necessary. The surgeon will mark exactly where these cells are situated on the Mohs map and use that information to plan for the second round. The process will then restart from stage one to ensure the surgeon removes all cancerous cells.
Although many Mohs patients have their wounds closed on the day of surgery, cancer that has spread significantly will sometimes require the removal of larger areas of skin. More advanced wound closure procedures, such as skin grafts or flaps, may be necessary in those cases. For the best aesthetic results, these more advanced procedures may need to be done on a separate day in collaboration with another surgeon.
Who Are Good Candidates for Mohs Surgery?
Mohs surgery works well against aggressive cancers and helps preserve healthy skin and aesthetic integrity in delicate facial areas. You could benefit immensely from Mohs surgery if you have one of the following.
Basal Cell Carcinoma
Basal cell carcinoma is the most common type of skin cancer and tends to grow very slowly. It’s commonly caused by ultra-violet (UV) light damage, so you’re more likely to develop basal cell carcinomas in places like your face, arms and hands because they get much more sun exposure. Mohs surgery gives you a great chance of walking out of the clinic cancer-free with minimal scarring.
Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) is the second most common type of skin cancer and is more likely to spread to deeper tissues than basal cell carcinoma. More Invasive cases on the neck and face are often treated with Mohs surgery with excellent outcomes. Studies show that patients treated with Mohs surgery were more satisfied with their long-term aesthetic results than those with conventional excisions, and the SCC was less likely to return.
Mohs Procedure for Melanoma
Melanoma is less common than basal or squamous cell carcinoma, and it has a significantly higher propensity to spread and grow deeply into the skin. Because of this increased malignancy, most melanomas above stage one and higher are removed using wide local excision (WLE), a procedure where a significant margin of skin is removed alongside the cancerous tissue. However, stage zero melanomas sit on the top layer of the skin and can still benefit from Mohs surgery.
Lentigo malignant melanoma is a type of skin cancer that mainly affects older adults and grows more slowly than other types. Before it progresses to invasive skin cancer, it appears as lentigo maligna, a precancerous skin condition.
Removing lentigo maligna is critical to prevent melanoma advancement, and Mohs surgery is one minimally invasive option, alongside modified Mohs procedures.
Slow Mohs Surgery
Slow Mohs surgery is a modified version of MMS that allows Mohs surgeons to see specific types of cancer cells more easily under a microscope. The difference lies in how the tissue cross-sections are processed. In traditional Mohs surgery, the sections are frozen, which allows surgeons to get results in as little as an hour. While most basal and squamous cell carcinoma cells are quite clear using this method, melanoma cells pose more of a challenge.
In slow Mohs surgery, the tissue samples are processed using paraffin, which takes closer to 24 hours to complete. After this lengthier process, the melanoma cancer cells around the sample margins are far easier to see. If you go for a slow Mohs procedure, you’ll be bandaged up and allowed to go home between rounds, and your Mohs surgeon will address wound closure after the final results are in.
Benefits of Mohs Surgery
When compared to conventional wide local excision, Mohs surgery has several key benefits.
Excellent Cure Rates
Mohs surgery has the highest cure rate out of all skin cancer treatments when removing basal and squamous cell carcinomas. It has a 99% cure rate for first-occurrence BCCs and SCCs and a 94% cure rate for cancers that have returned after previous treatment. Mohs surgeons check that all the cancer has been cleared under a microscope before closing the wound, ensuring the best results.
Minimal Scarring
Mohs surgeons remove as little tissue as possible in stages throughout your Mohs surgery — this means you keep the maximum amount of healthy skin and have smaller wound closures, helping preserve your original appearance. Tissue preservation is particularly beneficial for facial lesions because it typically leads to the best cosmetic results.
Immediate Results
Unlike some other skin cancer treatments, which require you to get multiple procedures over weeks or months, traditional Mohs surgery is usually done all in one day. Tumor removal, immediate pathology and expert wound closure all happen at the same clinic during one appointment.
Speak to a Fellowship-Trained Mohs Surgeon About Your Skin Concerns
At the Berman Skin Institute, we’re dedicated to blending state-of-the-art technological innovations with a compassionate approach to patient care. Our medical dermatology practices throughout Northern California offer a full range of services, including Mohs surgery for various carcinomas, precancerous sun damage treatment and much more.
Take charge of your skin’s health and get peace of mind. Book an appointment with us today.
