Mohs micrographic surgery is a treatment for skin cancer. Dr. Frederick Mohs at the University of Wisconsin developed it in the 1930’s. This specialized surgical technique is often used to treat the two most common forms of skin cancer – basal cell carcinoma and squamous cell carcinoma. Of the available treatment options, Mohs surgery has the highest cure rate for these forms of cancer.
Mohs surgery is performed in several steps. First, the surgeon marks the outline of the visible part of the skin cancer. Then the area to be treated is numbed with a shot of local anesthesia. Once the area is numb, the surgeon removes the cancer. Then the patient is bandaged and allowed to rest comfortably. While the patient waits, the removed skin is taken to the laboratory and processed into microscope slides. The surgeon then checks all of the edges and the under surface of the skin under the microscope to be certain that the skin cancer and all of its extensions or “roots” have been removed.
If the cancer has been completely removed, then plans are made to repair the wound. If there is more skin cancer remaining, then the process is repeated, but only areas of skin with remaining cancer are removed. The surgery continues in this way until the cancer has been completely removed.
Repair After Mohs Surgery
Once the skin cancer has been completely removed with Mohs surgery, plans for repair of the wound are made. Many wounds can be closed with a simple line of stitches. Other wounds heal best if the body is left to heal naturally without further surgery. Some wounds may require a more complicated form of repair including flaps or grafts where skin is moved from nearby or distant sites to close the wound. Occasionally the Mohs surgeon may refer the patient to another surgeon for repair of the wound.
Benefits of Mohs Surgery
The main benefit of Mohs surgery is that it has the highest cure rate of any available treatment for most forms of skin cancer. This is because all of the edges and base of the cancer are checked under the microscope at the time of surgery. Cure rates range from 95-99% for cancers that have not been treated previously. The second benefit is that the size of the surgical wound is as small as possible because only the skin affected by the skin cancer is removed. This results in less chance of damage to important structures that may be near the cancer such as the eyes, nose and lips. It also means that the scar will be smaller once the surgical wound has healed.
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Skin Cancer Destruction
Destruction is a simple and effective treatment for certain types of skin cancers. After the diagnosis of skin cancer has been confirmed by a biopsy and pathology testing, your dermatologist may recommend treatment by destruction. It is a good treatment option for small and superficial skin cancers, and is used commonly on the body.
After numbing the area, the cancer will be scraped with a tool called a curette until all of the cancer is removed. After the scraping is completed then the bleeding will be controlled using a chemical solution or electrocautery, followed by a routine bandage.
The treatment takes about 5-10 minutes to complete. It leaves a wound that looks like a scrape. There are no stitches. The wound usually takes about 6-12 weeks to heal. Once completely healed the treatment leaves a scar that is usually a flat, round, white spot.
Benefits of Treatment
Destruction of skin cancer is an effective treatment with estimated cure rates of 90% or higher for appropriately selected skin cancers. It is a relatively simple and efficient option and is less expensive than most other skin cancer treatments.
Alternate Skin Cancer Treatment Options
Occasionally skin cancer can be treated with topical chemotherapy creams, including Imiquimod and 5-Fluorouracil. These are used in select cases under the discretion of your Dermatologist. They generally cause local irritation and inflammation and require weeks to months of treatment.
Superficial radiation therapy is used in only select cases, generally in patient who are unable to tolerate surgery.