Mohs Cancer Surgery is microscopically controlled surgery that is highly effective for common types of skin cancer, with a cure rate of up to 99% for basal cell cancer, the most common skin cancer. Because the Mohs procedure is micrographically controlled, it provides precise removal of the cancerous tissue, while healthy tissue is spared. For this reason, Mohs surgery results in a significantly smaller surgical defect and an improved cosmetic result compared to other methods of skin cancer treatment. The Mohs procedure is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desired for cosmetic and functional purposes (the face, eyelids, nose, ear, fingers, genital area), for cancers with indistinct margins, and for recurrent cancers in scar tissue. It is especially indicated for lesions that have recurred following prior treatment, or for lesions in anatomic areas that have the greatest likelihood of recurrence (eg., the side of the nose).

Mohs surgery is expensive. For this reason, it should be used appropriately generally only for recurrent or facial cancers.

Mohs cancer surgery is performed by dermasurgeons and basically consists of three tasks: surgical removal of tissue (i.e. surgical oncology); interpretation of microscope slides (i.e. pathology); and reconstruction of the surgical defect (i.e. reconstructive surgery). Thus, Mohs surgery requires additional training both in frozen section microscopic interpretation and in the surgical technique for excising the cancer and then repairing the defect in a cosmetically acceptable manner. This training is done during many dermatology residencies and additional post-residency training is available.

A relatively new technique for large difficult basal cell cancers involves pre-operative shrinking of the tumor using topical imiquimod cream ("Aldara"), an immune enhancing agent. With the tumor smaller, the surgery requires removal of a smaller amount of tissue, making it easier for the patient and the dermasurgeon.

The American College of Mohs Micrographic Surgery and Cutaneous Oncology was established in 1967 and named after Frederic Mohs, who first developed the technique. This organization's members are physicians who have become proficient and experienced in the use of Mohs Micrographic Surgery. In order to become a member of this college, physicians must complete a post-graduate fellowship with exposure to complex tumors and reconstruction. The College has grown to nearly 800 members. Additionally, the American Society for Mohs Surgery is a non-profit professional medical society of over 700 dermatologists, pathologists, and Mohs technicians. Founded in 1990, the ASMS is dedicated to the highest quality patient care and education relative to Mohs surgery as a specialized surgical treatment for skin cancer.

Appropriate candidates should contact a Mohs dermasurgeon for evaluation and treatment of suspected skin cancer.

Dermatology