Mohs Micrographic Surgery

Mohs micrographic surgery is a refinement of an innovation in 1936 by Dr Frederick Mohs. It is a highly specialized outpatient surgery that offers the best cure rate for many skin cancers, while maximally sparing healthy tissue. The distinctions of this procedure are many and include;

1 Margin Control- Mohs surgery uniquely orients, maps, and processes removed tissue, which permits the microscopic evaluation of virtually 100% of the specimen margins. The completeness of this margin control permits the accurate identification and removal of all tumor extensions under the microscope. Tissues in Mohs surgery are processed as modified frozen sections, which allows the accurate and rapid interpretation of most skin cancers.

2 Cure rate- With complete margin control, Mohs surgery may achieve the highest cure rate for many skin cancers. For primary (cancers that have not been treated previously) basal cell cancers (BCC) and squamous cell cancers (SCC), Mohs surgery cure rates are 99% and 97% respectively. For recurrent (cancers that have returned from previous therapy) BCC and SCC, Mohs surgery cure rates are 94% and 90% respectively. These cure rates are higher than other conventional options.

3 Tissue Sparing- The preciseness of the Mohs process allows the Mohs surgeon to remove cancer growths one layer at a time, while maximally preserving healthy tissue. Wide safety margins, as used in traditional surgery are avoided while achieving an excellent cure rate. In fact, Mohs surgery removes 180% and 347% less tissue than traditional surgery for primary and recurrent tumors respectively [Bumstead RM, Ceilley RI. Auricular malignant neoplasms.Arch Otolaryngol 1982;108:225-31]. For the patient, the least tissue removed usually translates into the smallest wound possible and hence the smallest scar possible.

4 Outpatient Procedure- Mohs surgery is performed under local anesthesia and occasionally with mild sedation. Patients may avoid general anesthesia, return home immediately and have a rapid recovery. This can be a significant benefit for older patients, who are also the ones most susceptible to skin cancers.

5 Comprehensiveness- Mohs surgeons are Dermatologists who further specialize in the Mohs technique, and may either be members of the Mohs College or the Mohs Society. Members of the Mohs College undergo advanced training in the Mohs technique, usually 1-2 years, after Dermatology specialty. The advanced training focuses on the microscopic evaluation of skin cancers, surgical and non-surgical treatment of benign and malignant skin tumors, reconstructive surgery, and other procedures (laser surgery, scar revision, etc). Consequently, Mohs surgeons are often highly skilled in not only removing the skin cancer, but also in repairing the wound defect. As a result, cancer removal, tissue analysis, and wound reconstruction are all completed usually in one appointment. Other methods may require several different consultation visits and surgeries.

6 Correlation- With complete margin control, Mohs surgeons may be able to detect under the microscope tumor features that were not seen on the original biopsy. Because these features may affect the tumor prognosis, additional consultation and therapy may be recommended, thereby improving the patient’s chances for tumor control.

Despite its many advantages, Mohs surgery should not be applied for every skin cancer. The meticulous nature of Mohs surgery is time intensive. Depending on the cancer, one tumor may require several hours to an entire day to clear and repair. Some cancers are not accurately seen with the frozen sections in Mohs surgery. Finally, cancers that have already spread to lymph glands or elsewhere are not treatable with this technique.

Mohs micrographic surgery is best indicated for skin cancers that are at higher risk for tissue destruction, recurrence, or metastasis. These high-risk features include;

1 Location: Skin cancers on the head and neck (Figure), especially on or near the temple, ears, eyes, nose, mouth and lips. These sites are cosmetically and functionally important and maximally preserving healthy tissue becomes critical. Further, skin cancers in these areas may also be more aggressive. Other non-facial locations, such as the genitalia, hands and feet, and fingers and toes may also be considered for Mohs surgery. to achieve high cure rate and maximally spare healthy tissue.

2 Recurrence: Tumors that return from previous treatment are at higher risk. Generally, they are more difficult to cure, behave more aggressively, and destroy more tissue. Mohs surgery is ideal for many recurrent skin cancers and achieves the highest cure rate.

3 Size: cancers greater than 2 centimeters (7/8 inch) are more difficult to treat and may be more aggressive.

4 Histology: The initial biopsy may reveal high-risk features such as infiltrative, morpheaform/sclerosing, micronodular, deeply invasive, spindle cell, perineural, poorly differentiated, etc Mohs surgery may achieve an excellent cure rate for these higher risk skin cancers.

5 High-Risk patients: patients who have certain genetic conditions (Basal cell nevus syndrome, albinism, etc) or who are immunosuppressed (organ transplant recipients, HIV/AIDS, leukemia/lymphoma, etc) may develop not only more skin cancers, but also more aggressive skin cancers. Mohs surgery should be an integral part of therapy for skin cancers in these patients.

 

 

Location & Contact

6655 Travis Street,
Suite 980
Houston, Texas 77030

713.500.8320

713.500.8321 fax

Services

• Medical Dermatology
• Cosmetic & Surgical Dermatology
  • Botulinum Toxin
  • Chemical Peel
  • Dermabrasion
  • Laser Surgery
  • Mohs Micrographic Surgery (MMS)
• Pediatric Dermatology
• Laboratory Dermatology