What Is Mohs Micrographic Surgery?

Procedure for removing skin cancer has a high success rate and shorter recovery

One in five Americans is likely to develop skin cancer in their lifetime, making it the most common type of cancer in the U.S. The good news is that it’s highly treatable when caught early.

One of those treatment options is Mohs micrographic surgery, which allows a physician to precisely remove the cancer and ensure all the cancerous cells are gone before the patient leaves the office.

“Using Mohs micrographic surgery, I am the surgeon and the pathologist. I can process the tissue in a way where I can see the entire edge and underneath,” says Maxim Polansky, MD, a fellowship-trained and board-certified Mohs surgeon at RUSH.

“With typical skin cancer removal surgeries, the pathologist is only examining a small portion of the tissue.”

Polansky pursued the highly specific clinical training for Mohs micrographic surgery because it allows him to be a part of the clinical evaluation, pathological diagnosis and surgery for each of his patients. That means he’s able to guide patients through the process from start to finish.

Results in 'real time'

Named after Frederic Mohs, MD, Mohs micrographic surgery refers to a technique developed in the 1930s in which a specialist examines the tissue sample under a microscope for cancerous cells in real time, Polansky explains.

Today, Mohs micrographic surgery is used to treat skin cancer by removing the cells and examining them under a microscope to make sure all the cancerous cells have been removed.

Other techniques for removing cancerous cells can result in either having to remove more skin than necessary, or not being able to remove all the cancerous cells and requiring another procedure, Polansky says.

Mohs micrographic surgery allows the provider to remove the cancer, process it and give the patient results. Then if more tissue needs to be removed, the physician repeats the process again.

Benefits of Mohs micrographic surgery

While Mohs micrographic surgery is more effective at removing skin cancer, an additional benefit is the quick nature of the procedure and healing process.

As an outpatient procedure, once the physician has confirmed they have removed all the cancerous cells, patients are allowed to go home the same day. Within two weeks, patients typically can return to their regular routine.

Mohs surgery is often used on skin cancers of the head and neck because it allows the surgeon to make a smaller, more precise excision and scarring is minimal, Polansky says.

It's most commonly used for basal cell carcinomas and squamous cell carcinomas, Polansky says, along with more rare tumors like dermatofibrosarcoma protuberans (DFSP) and atypical fibroxanthomas. 

With other skin cancer removal surgeries, the success rate is around 90% to 95%, which means there’s a 5% to 10% chance that the cancer can come back and require more extensive treatment, Polansky says.

“I often have patients ask if their cancer is going to come back. The general perception of the removal of cancer for patients right now is that we’ll try and get it all but might not be able to,” Polansky says. “It speaks to me the most that I can tell my patients, this procedure has a 99.9% cure rate.”

Advice from the specialist

Regular mole checks and an annual appointment with a dermatologist can help you catch skin cancer early, which makes treatment even more effective.

If you are concerned about an abnormal skin lesion or have been diagnosed with skin cancer, talking with a dermatologist can help you choose the best plan of action.

“For every kind of patient, there’s a best possible option for treatment,” Polansky says. “I talk with my patients about all of the options, surgical or not, and help them decide what will be the best treatment plan for them.”

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