Mohs Surgery for Skin Cancer

Mohs surgery is a procedure that removes skin cancer in several steps. It is one of the most successful techniques for treating the two most common kinds of skin cancer—basal cell and squamous cell cancer.

How Skin Cancer Develops

Skin cancer is the most common cancer in the US, with basal cell carcinoma making up about 80 percent of all skin cancers. Sunlight and artificial ultraviolet light from tanning beds, sunlamps and other such sources are often responsible. Basal and squamous cell cancers typically occur on areas of the body that get the most sun exposure, like the face, nose, ears, neck, hands, arms, and scalp.

Treating Skin Cancer With Mohs Surgery

Basal cell carcinoma and squamous cell carcinoma are very easily treatable if diagnosed early and managed correctly. Mohs surgery is the gold standard treatment for the majority of basal and squamous cell carcinomas.

Mohs surgery is unique because it allows the surgeon to remove all of the cancer cells while preserving as much of the healthy surrounding tissue as possible. This is important on the face and other areas that are highly visible but where there is not much tissue to spare.

Mohs surgery is used for patients with a high risk for recurrence after previous treatment, skin cancers with ill-defined borders, and large or aggressive skin cancers.

“Mohs surgery is the treatment that provides the highest certainty that the skin cancer is completely removed.”  
Abhishek “Shek” Aphale, MD, Assistant Professor of Dermatology at Fox Chase Cancer Center

The Importance of a Trained Mohs Surgeon

Trained Mohs surgeons have expertise in all phases of the procedure. They act as the oncology surgeon, the pathologist, and the reconstructive surgeon. Complete tumor removal is the priority, but specific techniques are also used to make sure that the scar is well-camouflaged, and as esthetically pleasing, as possible. The face, head, and neck heal well in general, so that it is typically difficult to see a scar a few months after Mohs surgery.

Minimally Invasive Surgery

Mohs surgery is usually done on an outpatient basis. It requires little preparation—patients can eat and drink normally and, in most cases, take their normal medications prior to surgery.

With appropriate diagnosis, treatment and follow-up, most of these cancers can be cured with excellent functional and cosmetic results.

The surgeon anesthetizes the area, removes the visible part of the cancer and a thin margin of tissue around and under it, then looks at it under the microscope to see if the edges are clear. The removal and analysis procedure is repeated until the last sample is cancer-free and only healthy tissue remains. Most surgeries take 2-3 hours, mostly because of the time it takes for tissue processing and microscopic analysis.

After the procedure is done, the wound is typically stitched together to heal. Two or more layers of sutures may be used. If non-absorbable sutures are used for the outer layer, the patient returns in 1-2 weeks for removal, depending on the area of the body affected.  Patients are typically asked to return in 4-6 weeks for a brief examination and to address any concerns, although few patients have any serious complication.