American College of Mohs Surgery

This video by the American College of Mohs Surgery available on Youtube explains the Mohs process concisely and clearly.  The South African model differs in some minor details but produces the same results with high cure rates and good reconstructive outcomes.

The warmth of the sun feels good on our skin but overexposure to the sun’s rays can be dangerous. UV radiation can penetrate our epidermis and damage the DNA in our skin cells over time and this can lead to skin cancer. Skin cancers are like icebergs with the tip of the tumor visible above the skin and the bulk of it underneath. There’s no way of predicting the extent of the cancer growth before treatment begins. Sun damage is the most common cause of basal cell and squamous cell carcinomas both of which are on the rise.

Mohs Micrographic surgery is usually the most effective treatment for the common areas where these skin cancers appear on the sun exposed areas of the head and neck. Performed on an outpatient basis, most surgeries significantly reduces damage to the surrounding tissue while effectively removing all traces of cancer. First your fellowship trained Mohs surgeon marks the tumor with a pen. There is no need for the patient to undergo general anesthesia and patient comfort is a priority, so before the Mohs surgery procedure begins the affected area is numbed with a local anesthetic then the surgeon excises a saucer-shaped piece of tissue with one to two millimeter margins around and below the marked border.

Marks are made on the skin to maintain specimen orientation. A bandage is placed over the patient’s surgical site and he or she will wait comfortably while the excised tissue is taken to an on-site lab where it’s prepared for microscopic evaluation. Most procedures can be completed in several hours but some cases will take longer. Your fellowship-trained Mohs surgeon who has training in skin pathology carefully examines a tissue sample under a microscope to see if the cancer has been completely removed. If residual tumor is found it’s marked precisely on the map. A second most layer is excised only in the positive area. This process is repeated until all the margins are free of tumor. Your Mohs surgeon will explain the most effective means of surgical site closure and post-operative care at the time of your procedure.

Small simple wounds in appropriate areas are allowed to heal naturally by a process known as second intention. Most wounds are closed with a linear repair, a side-to-side stitching of the surgical site to close a circular wound. Extra tissue on either side of the circle is trimmed so that the suture line lies flat. Larger or more complicated wounds may require skin grafts or a flap which closes a surgical site by moving adjacent looser skin to fill in the wound. There will be some scarring once the area is healed although scars from Mohs surgery are often smaller and less visible than those from other excision procedures. As a member of the American College of Mohs Surgery your Mohs surgeon has undergone residency training in dermatology prior to a rigorous one to two year fellowship and Mohs micrographic surgery and dermatology and he or she performs more than 500 Mohs Surgery cases. These cases not only include the pathologic interpretation of both common and unusual tumors but also performing routine and complex reconstruction. Our primary goal in performing Mohs surgery is to cure your skin cancer and to preserve normal tissue compared to other skin cancer treatments. Mohs surgery has a very high success rate of up to 99%. You can trust the hands of a fellowship-trained Mohs surgeon to give you the optimal result you deserve.