If you are seeking treatment for skin cancer, your provider may suggest Mohs surgery as a treatment option.
Mohs surgery is considered the most effective method for treating many cases of basal cell carcinoma or squamous cell carcinoma—two of the most common types of skin cancer.
Mohs surgery can be an appropriate option for many cases, especially for recurring tumors or those located on the head and neck.
It can take the place of wide local excision, a method of skin cancer removal that requires the removed tissue to be sent away for examination.
How It Works
One of the unique advantages of Mohs surgery is that all the skin cancer cells can be removed in one day.
That's because you won't have to wait for the removed skin to be sent off to a pathologist. A Mohs surgeon is specially trained to act as both a surgeon to remove the skin and a pathologist to examine it.
“Patients should plan for their procedure appointment to last several hours to a full day, and to go home knowing that their cancer has been properly diagnosed and fully treated in a single procedure,” says Mariana Phillips, M.D., section chief of Dermatology and Mohs Surgery at Carilion Clinic.
She and Kyle Prickett, M.D., are fellowship-trained Mohs surgeons—and the only Mohs surgery providers in our region with advanced fellowship training.
Mohs surgery is an in-office procedure that doesn't need to be performed in a hospital setting or require general anesthesia. Your surgeon will use local anesthesia to numb the affected area and you will remain awake and alert throughout the procedure.
Your surgeon will carefully remove the visible layer of the skin cancer tumor, plus a small amount of the skin surrounding it.
While you wait in the surgery suite, your surgeon will take the removed skin to the laboratory and examine it under a microscope.
If no additional cancer cells are found on the surrounding edges or underside of the visible tumor, then your surgery could be over at this point.
If your surgeon finds more cancer cells, then it's time to remove and examine another layer.
This step-by-step, layer-by-layer cycle of removing and examining continues until no more cancer cells remain.
Once no additional cancer cells are found on the surrounding edges or underside of the visible tumor, then your surgeon will decide whether to let the wound close on its own, or to use stitches or other methods to help it heal.
The entire process can take several hours, depending on how many layers need removal. But your surgery will be completed in one visit, and you will be able to go home at the end of the procedure day.
Your surgeon will give you aftercare instructions to help you keep your wound clean and allow it to heal as quickly and with as minimal a scar as possible.
Benefits of Mohs Surgery
Mohs surgery is highly effective: It has a 98-percent cure rate as a first-time treatment and a 95-percent cure rate when used on skin cancer that has been treated before.
It allows the surgeon to examine all the edges of the tumor at one time. This is important since the visible tumor can be just "the tip of the iceberg," with more skin cancer cells below and surrounding it.
And thanks to the precise, layer-by-layer removal process, Mohs surgery leaves behind as much healthy tissue as possible—which often improves the cosmetic outcome.