Mohs Micrographic Surgery
Mohs micrographic surgery offers the highest cure rate for the treatment of basal cell and squamous cell carcinomas (~99%). Because the physician performing the procedure must function as both the surgeon and the pathologist, the accuracy of the cancer mapping is greatly enhanced. It is particularly helpful for large tumors, recurrent tumors, tumors near important structures such as the eye or lip, and aggressive tumors (such as those occurring in young patients or those growing rapidly). Mohs surgery allows viewing of 100% of the margin, whereas the standard permanent sectioning only allows viewing of <1% of the margin.
Mohs surgery is performed as follows:
1) The tumor is excised with a narrow rim of normal-appearing tissue.
2) The specimen is sectioned (if necessary), stained, and marked on a detailed diagram.
3) The tissue is frozen and thin slices are removed from the entire periphery. The tissue is then placed on a glass slide and stained in preparation for microscopic exam.
4) Once the slides are prepared, the dermatologist reviews them and notes whether or not any cancer cells remain. The results are then diagrammed on the Mohs map.
5) If all cancer cells are gone, a closure of the wound is performed. If they are not, then only the areas where cancer remains are re-excised and the process is repeated. This allows the smallest amount of normal tissue to be removed, so that repairs are easier and more cosmetically pleasing.
When scheduled for Mohs surgery, you should plan on being in the office all day. The procedure usually takes less than a day, but it is impossible to know in advance how many layers it will take to remove all the tumor. Because the procedure is performed under local anesthesia, you should eat and take your normal medications (including blood thinners) before coming to the office. If you normally take medicine during the day, please bring it with you so that you may take it at the appropriate time. You should have someone with you or make arrangements for someone to drive you home after the procedure.
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