The benefits of Mohs Surgery
Mohs micrographic surgery is a very precise, highly detailed and specialized approach for skin cancer removal used at our Laguna Beach, CA dermatology practice. What makes Mohs micrographic surgery unique is that it involves the combination of removing cancerous skin tissue and examining the tissue in real-time, until all traces of the cancer have been successfully removed.
Whereas traditional skin cancer surgery involves the removal of skin cancer tissue that is then sent to a laboratory for analysis of 2% of the surgical margins that may take days, during Mohs, layers of tissue are surgically removed, immediately stained and 100% of the margin is examined under the microscope for residual cancer. Dr. Farah ‘Bobby’ Awadalla, our fellowship trained Mohs surgeon, then draws a very exact tumor map detailing the exact areas of residual cancer cells. If more cancer cells are detected, another layer is removed. Repeated layers of tissue are removed and examined until no more skin cancer can be microscopically detected.
By the repetitious process of removing and testing the tissue, the technique combines the highest cure rate with excellent preservation of the surrounding normal skin. Once the cancer has been fully removed, our board certified dermatologists will expertly repair the wound to ensure very limited scarring. Traditional surgical pathology techniques only evaluate 1%-3% of the tumor margins, thereby increasing the chances that a portion of the tumor being missed and recur. Mohs micrographic surgery enables the examination of 100% of the entire tumor’s margin, thereby reducing the chance of recurrence.
Another advantage of Mohs is that it is performed while the patient is in the office. This means that the patient will know when the entire skin cancer is completely removed and Dr. Bobby Awadalla can then move on to planning and executing a closure. This is different than traditional surgical techniques where the skin cancer is removed and the tissue sent to the lab, which can take up to a week to get the results. With traditional surgery if the delayed analysis at the margins is not clear, a second surgery would be required.
Mohs micrographic surgery is significantly more labor intensive than conventional methods of treating skin cancers, and as a result, it is more expensive. This type of surgery is typically reserved only for certain situations, including:
- Recurrent cancers
- Large tumors with indistinct margins
- Tumors that occur in cosmetically sensitive areas like the mid-facial tissues
- Scarring basal cell cancers
Why is the procedure called Mohs?
Mohs is named after its inventor, Dr. Frederic Mohs, who first described the technique in 1941. He originally used fixed stained tissue and patients were frequently required to spend more than one day for successful treatment. The technique of removing horizontal pieces of tissue from the deepest portion of the specimen while at the same time visualizing the outside edges of the tumor in the same block of tissue is unique. The technique has evolved over time to become highly specialized with cure rates approaching 100%.