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• Highest cure rate. Because all surgical margins are examined microscopically in the office, this procedure has the highest cure rate of all skin cancer treatments.
• Best cosmetic result. Because there is no need to take a margin of healthy skin in Mohs surgery, the size of the wound left after tumor removal is minimized. Keeping the defect small optimizes the surgical repair, and produces a superior cosmetic result.

Basal Cell Carcinoma

The most common type of skin cancer is basal cell carcinoma. Often these skin cancers are very subtle, and appear like a small pimple that will not heal and often bleed. The second most common skin cancer is squamous cell carcinoma. This type is usually appears as a thickened scaly plaque or nodule. The third most common type is melanoma, which behaves differently that either basal cell carcinoma or squamous cell carcinoma. Melanoma most commonly appears as an abnormal mole.

Fortunately, the two most common types of skin cancer, basal cell carcinoma and squamous cell carcinoma, are rarely life threatening. As a general rule, basal cell carcinoma does not spread to the glands or other parts of the body. Compared to basal cell carcinoma, squamous cell carcinoma has an increased risk to spread to other parts of the body. Fortunately distant spread is uncommon when the cancer is treated early. However, both types of tumors will continue to grow locally and destroy normal tissue. The third most common type of skin cancer, melanoma, can be life threatening if treated late. Basal cell skin cancers and squamous cell cancers never “turn into” melanoma.

Mohs surgery is an outpatient procedure that is performed under local anesthesia; therefore the risks associated with prolonged general anesthesia are avoided. Before the surgery begins, a small needle is used to place the numbing medicine (lidocaine) in the area surrounding the skin cancer. After this first step, the remainder of the procedure is relatively pain free. The surgeon first removes the obvious skin cancer that can be seen with the unaided eye. Then a very thin saucer-shaped layer of normal appearing skin is removed taking special care to map the tissue so that the surgeon is able to determine the corresponding margins on the patient.

The tissue is then processed by the laboratory located in our office – a process that takes about an hour. A temporary bandage is placed over the site and the patient waits in the waiting room while the tissue is processed.  After processing, the surgeon uses a microscope to trace the roots of the skin cancer to see if the entire tumor has been removed. If the margins are clear, and the tumor has been completely removed, then the surgeon will repair the wound that was created by tumor removal. If the margins are not clear, meaning that some of the tumor was left behind, then the surgeon will go back and remove the edges only in the area where the roots were left behind. This will likewise be processed and examined with a microscope. This process is repeated as many times as necessary until the entire tumor is removed.

The repair usually involves sutures.  In addition to wound size and location, the surgeon considers other factors in determining how your wound will be handled. There are three main ways a surgical wound may be handled:

1. Direct closure of wound with stitches. This is the most common method.
2. Skin graft or flap: In some instances, it is necessary to remove skin from behind the ear or some other site and graft it over the wound. Other times skin that is located near the wound is moved in to fill the defect left from surgery – this is a skin flap.
3. Let wound heal in by itself. The body has an excellent capacity to heal open wounds. This healing period is approximately three to six weeks depending on the size of the wound. It requires regular wound care.

Skin cancers may have extensions or roots beneath the skin that are invisible to the naked eye. No one can predict how many layers will be necessary to completely remove the cancer. For this reason it is impossible to predict how large the final wound will be or how long the procedure will take.  Therefore, it is important for patients to plan on spending the entire day with us. Bring a good book and whatever else will help keep you comfortable while you are with us.

Learn more about Mohs surgery from the American College of Mohs Micrographic Surgery and Cutaneous Oncology.

We look forward to making sure your experience with Mohs Micrographic Surgery is a positive one and appreciate the opportunity to serve you.

Dafnis C. Carranza, MD
Board Certified Dermatologist
American College of Mohs Micrographic Surgery Fellowship Trained