What is Mohs Micrographic Surgery?
The Mohs technique is a highly specialized treatment for complex skin cancers performed by Dr. Andrew Jun. Distinct from surgical excision, the Mohs technique involves removing layers of tissue. The tissue is then mapped, color-coded and processed onto microscope slides. Then, on the same day of surgery, Dr. Jun will evaluate 100% of the tissue margin to ensure that the entire skin cancer has been removed. Additional layers are taken until all tumor has been removed.
What is Mohs surgery used for?
The majority of tumors treated with Mohs surgery are complex basal cell carcinomas and squamous cell carcinomas. Other uses include more rare skin cancers, as well as thin melanomas. Skin cancers may be considered complex when:
- The cancer is in an area where preservation of healthy tissue is critical to minimize scarring and maximize function and cosmesis
- The cancer is in an area of higher tumor recurrence (ears, lips, nose, eyelids, temples)
- A cancer is in a previously treated area and is recurrent
- A cancer is very large
- The margins of the cancer are not well defined
- The patient is immunosuppressed (e.g. organ transplantation, HIV infection, chronic lymphocytic leukemia
What is the advantage of Mohs surgery?
Mohs micrographic surgery results in the highest cure rate while minimizing the removal of normal tissue.
The Mohs micrographic surgery process:
Step 1: Anesthesia: the tumor site is numbed using local anesthesia. General anesthesia is not necessary for Mohs surgery.
Step 2: Removal of visible tumor is then performed by surgically removing a thin, saucer shaped “layer” of tissue.
Step 3: Mapping the tumor using orientation to landmarks (eye, nose, etc) and color-coding each section to match.
Step 4: Evaluation of processed tissue by the Mohs surgeon who will determine if margins are clear, or alternatively if additional “layers” will need to be removed to clear the tumor.
Step 5: Additional stages taken if needed to ensure all cancer cells are removed.
Step 6: Reconstruction of the wound created by removal of the tumor. The best method of repair is chosen only after the cancer has been completely removed. Stitches may be used to close the wound side-to-side, or a graft or flap may be designed. In some instances, a wound may heal very well naturally.