Mohs Surgery

Mohs Surgery

Mohs surgery is a highly specialized procedure for the treatment of skin cancers. The technique was first developed in the 1930’s by Dr. Fredrick Mohs. Mohs surgery is a procedure in which a highly trained dermatologic surgeon removes one layer of skin tissue at a time and examines that skin tissue under the microscope to ensure the complete removal of a skin cancer. The goal of the procedure is to completely remove the skin cancer while preserving the maximum amount of healthy surrounding skin.

Mohs surgery is most commonly performed for the treatment of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), which are the two most common forms of skin cancer. It is typically the best option for treatment of these cancers on sensitive areas such as the face, ears, and hands, but may also be recommended for other areas depending on the characteristics of the skin cancer.

What are the advantages of Mohs surgery?

Mohs surgery offers the highest cure rate for the removal of basal cell carcinomas and squamous cell carcinomas, 97-99%. The procedure is very safe and performed only with local anesthesia. Mohs surgery allows for the tumor to be removed and examined under the microscope to ensure all of the “roots” of the cancer have been excised. It is referred to as “tissue-sparing”, meaning that only the skin tissue where cancer is identified is removed, and the remaining healthy skin is left intact.

What are the steps of the procedure?

During Mohs surgery, the site of the skin cancer is identified. The area is numbed with an injection of local anesthesia. The skin cancer is then cut out and taken to the lab to be examined under the microscope. The Mohs surgeon evaluates the tissue under the microscope to ensure that all of the skin cancer has been removed and the margins of the tumor are clear. If there is still skin cancer present, the Mohs surgeon will go back to the area and remove another small piece of skin, only from the specific site where cancer was still seen under the microscope. This skin tissue will then also be examined under the microscope. This process is repeated until no more skin cancer is seen and the margins are clear or “negative”. Once the skin cancer has been completely removed, the Mohs surgeon will close the skin with stitches.

What should be expected on the day of surgery?

On the day of Mohs surgery, please plan to spend the entire day with us. Each time the skin tissue is examined under the microscope, there will be a waiting period of around one hour or more. In some cases, patients only need one round of skin tissue removal and microscopic examination. However, oftentimes patients need multiple rounds, which can take multiple hours. Patients undergoing Mohs surgery will be in the office until the procedure is complete. We recommend eating a light breakfast in the morning and bringing lunch with you. We also recommend bringing something to pass the time, such as a book or an iPad. You are welcome to bring a friend or family member with you to drive you home at the end of the day (this may not be necessary for all patients and can be clarified ahead of your procedure).

Scheduling Mohs Surgery

You will have a full consultation with one of our providers prior to your Mohs surgery. During that consultation, the procedure will be discussed in detail and all of your questions will be answered prior to scheduling. We will also go over your full medical history at this time. Please remember to bring a list of your medications with you to this appointment so that detailed guidance can be provided on which medications should be continued or stopped prior to your surgery. After your consultation, our staff will assist you in scheduling your surgical appointment with Dr. Warthan.