Pioneered by Frederic E. Mohs, MD, in the late 1930s, but was not widely known, it was initially known as chemosurgery. Change to the procedure came in the mid-60s when Dr. Perry Robins, who studied the procedure with Dr. Mohs, understood the potential for the field of dermatology. Dr. Robins further advanced the technique to what it is now known in dermatological medicine as Mohs Micrographic Surgery.
What makes this procedure unique is that it is done in stages while the patient waits in the office. The skin tissue is removed by the Mohs surgeon and the pathology slides are made in our dermatopathology lab and then prepared for the surgeon to look at under a microscope to determine if all cancer cells have been completely removed. If there are still residual skin cancer cells, the staging process repeats, and more skin tissue is taken. This process allows for the highest cure rate while sparing healthy tissue and leaving the smallest possible defect and scar.
After the skin cancer has been completely removed, you and your doctor will decide on the best route for post-surgery care, which may include: Placing sutures to close the wound (primary closure), letting the wound heal on its own (healing by secondary intention), shifting skin from an adjacent area (skin flap) to cover the wound, or using a skin graft from another part of the body, such as behind the ear, to cover the wound. If the surgical area is extensive or complex, your surgeon may temporarily close your wound and then refer you to a plastic surgeon for reconstructive repair. A follow-up visit with your surgeon may be required to monitor your recovery to make sure your wound is healing properly.
Benefits of Mohs Surgery
Mohs surgery offers more efficient, cost-effective treatment for patients over other types of surgical procedures because it typically only requires a single, out-patient visit with only local anesthesia. With Beaird Dermatology's on-site dermpath laboratory, Mohs surgery saves invaluable time and speeds up the treatment process. In fact, Mohs surgery has the highest cure rate: Up to 99% for a skin cancer that has not been treated before and Up to 94% for a skin cancer that has recurred after previous treatment. The advantage of Mohs surgery is that the patient leaves our office with the peace of mind that their skin cancer has been completely removed.
What is Slow Mohs?
Slow Mohs is a staged surgical excision used to remove malignant melanoma while trying to save as much adjacent healthy tissue. Slow Mohs is a modified form of Mohs micrographic surgery, the patient has a stage of tissue taken and is then bandaged and sent home. Rush permanent sections are then sent to the dermatopathologist for processing and evaluation. The patient will be contacted on the next steps pending their results. If the margins come back clear with no residual malignant melanoma, the patient will return to the office to have their site closed. If the margins are positive for melanoma, the patient will return for further removal and the process will repeat until the melanoma is completely removed.