What is Mohs Surgery?

Mohs Micrographic Surgery (Mohs Surgery or Micrographic Surgery) is the most effective surgical technique for treating skin cancer. It offers the highest cure rate, up to 99%, while providing the best cosmetic outcome (it keeps you looking beautiful!).

The primary goal of skin cancer surgery is to remove 100% of the skin cancer and as little of your normal skin as possible. Mohs Micrographic surgery examines 100% of the margin (edges) of the specimen that is removed. This means that 100% of the side and bottom edges of the specimen are examined microscopically to ensure that there are no skin cancer cells at the edges. Mohs Surgery provides the highest cure rates for skin cancer, 99%, the smallest scar, and the best cosmetic outcome.

Who performs Mohs Surgery?

Mohs Surgeons are double Board-Certified in Mohs Micrographic Surgery and Dermatology. Highly skilled Mohs Surgeons also complete a fellowship in Mohs Micrographic Surgery.

What does being a Mohs Surgeon involve?

• The Mohs Surgeon is the surgeon who removes skin cancer
• The Mohs Surgeon is the pathologist who examines the specimen under the microscope to look for cancer “roots.”
• The Mohs Surgeon is the expert in facial reconstructive surgery (Keeps you looking beautiful!)

Mohs Facts:

• Mohs Surgeons perform more complex facial reconstructions than any other surgical specialty.
• Mohs Surgery is named after Dr. Fredrick Mohs, who pioneered Mohs surgery for skin cancer. Although Dr. Mohs did not want this surgical technique named after him, it was named after him to honor his legacy of innovation and the impact this surgical technique had on improving patient outcomes.

Advantages of Mohs Surgery:

• The best outcome of any skin cancer surgery or treatment – cure rates up to 99%
• The best cosmetic outcome of any skin cancer surgery
• A single visit for your skin cancer surgery and reconstruction
• Outpatient surgery under local anesthesia: making Mohs Surgery the most cost-effective skin cancer surgery, which saves you money

Mohs Surgery = Precision

• 100% of the tumor specimen is examined
• 99% cure rate for most skin cancers
• Spares your healthy, normal tissue

If you do not have Mohs Surgery, less than 1% of the tumor margin (the edges of the specimen) is examined.

Why is Mohs Surgery better than traditional surgery?

Traditional surgery involves the surgeon removing the skin cancer and sending it to an outside lab, where a pathologist examines the tissue. The tissue is “bread loafed” – imagine a loaf of bread and remove a few slices to examine under the microscope. The entire crust of the bread is not examined, leaving most of the edges unexamined. This has resulted in high recurrence rates for facial skin cancers, greater than 10%. Mohs Micrographic Surgery examines 100% of the tumor edges and the entire bread crust to ensure no tumor at the edge of the specimen. This is why Mohs Surgery has up to a 99% cure rate; the surgeon examines 100% of the tumor’s edges.

After your skin cancer has been treated with Mohs Micrographic Surgery – you are skin cancer-free. With conventional surgery, patients typically wait up to 1 week for results to know if the surgeon removed the skin cancer or if some of the cancer still remains. With conventional surgery, if skin cancer still remains, the patient must undergo another surgery and will have to wait an additional week to find out the results.

Benefits of Mohs Micrographic Surgery and Office-based Surgery

1. Best Outcome: Mohs Micrographic Surgery provides a high cure rate for the treatment of skin cancer
2. Safety: local anesthesia is safer than surgery performed under general anesthesia
3. Less-expensive: Office-based surgery is less expensive than surgery performed in the operating room. Treating skin cancer in an operating room with conventional surgery can be more than 25 times more expensive than Mohs Micrographic Surgery. This is especially important for patients with high-deductible insurance plans.
4. No restrictions on eating or drinking. You should eat breakfast the morning of your surgery.
5. Take your regular scheduled medications.
6. Bleeding is well controlled. Take your prescribed blood thinners (aspirin, coumadin, Plavix, and others). Bleeding complications are easier to treat than a stroke or heart attack.
7. Patients can usually drive themselves home unless surgery is performed near the eye.

How is Mohs Surgery Performed?

Mohs Surgery is performed in stages:

• Stage 1: The skin cancer is removed by the surgeon under local anesthesia.
• Stage 2: The skin cancer specimen is processed in a CLIA-certified lab so it can be examined microscopically
• Stage 3: Your skin cancer specimen is examined microscopically to look for tumor “roots”
• Stage 4: If microscopic skin cancer remains (tumor “roots”), Stages 1 & 2 are repeated until there are no more skin cancer “roots”
• Stage 5: The wound is reconstructed to keep you looking beautiful!

Stage 1: The skin cancer is removed by the surgeon under local anesthesia.

The Mohs Surgeon will discuss your diagnosis and tell you about Mohs Surgery. The Mohs Surgeon will then examine your skin cancer and numb the area with local anesthesia. The skin cancer is removed with a scalpel, inked with color dyes, and mapped like a clock dial: 12 o’clock, 3 o’clock, 6 o’clock, & 9 o’clock. If a tumor is seen under the microscope, the map lets the surgeon know precisely where the tumor is located.

Stage 2: Our Centers for Medicare and Medicaid Services CLIA-certified laboratory processes your skin cancer specimen.

Our technician will process your specimen so it can be examined microscopically. Depending on the complexity of the specimen, this process can take 45 minutes to 2 hours (if you were having conventional surgery, it could take up to 1 week).

Stage 3: Using a microscope, the Mohs Surgeon examines 100% of the margin of your skin cancer specimen (100% of the edges and underside of the specimen).

Mohs Surgery is the only surgery where 100% of the edges are checked to ensure no skin cancer at the edge. Because the skin cancer specimen was mapped, if a tumor is seen at the edges of your specimen, the Mohs Surgeon can precisely identify where this tumor is located. This allows your Mohs Surgeon to remove the skin cancer and leave normal skin. Mohs Surgery is the only technique where this is possible.

Stage 4: If microscopic skin cancer remains (tumor “roots”), Stages 1 & 2 are repeated until there are no more skin cancer “roots”

Stage 5: The Mohs Surgeon will assess your wound and facial appearance to restore contour, texture, and color.

Restoring Form & Function:

We restore volume, color, and texture to ensure you have the best cosmetic outcome. Mohs Surgeons are the experts in facial reconstructive surgery, performing more complex facial reconstructions than any other specialty.

Mohs Micrographic Surgery is approved for the treatment of rare skin cancers:

• Melanoma
• Melanoma in situ
• Adenocystic carcinoma
• Adnexal carcinoma
• Apocrine/eccrine carcinoma
• Angiosarcoma
• Atypical fibroxanthoma
• Dermatofibrosarcoma protuberans
• Extramammary Paget’s disease (EMPD)
• Leiomyosarcoma
• Malignant fibrous histiocytoma/Undifferentiated pleomorphic sarcoma
• Merkle cell carcinoma
• Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma)
• Mucinous carcinoma
• Sebaceous carcinoma
• Other rare cutaneous malignancies

Mohs Surgery & Mohs Procedure St. Louis

Mohs Micrographic Surgery offers the highest surgical cure rate among all treatments for skin cancer. This technique preserves your normal skin, focusing on removing skin cancer, minimizing scarring, and maximizing your cosmetic outcome. Mohs Micrographic surgery is the most advanced treatment for skin cancer.

Mohs Micrographic Surgery is the only surgical technique that examines 100% of the margin (edges) of the specimen (skin cancer) that is removed. This means that 100% of the side and bottom edges of the specimen are examined microscopically to confirm that there are no skin cancer cells at the edges. This provides patients with the highest cure rates, the smallest scars, and the best cosmetic outcomes for their skin cancer.