Mohs surgery is unique and so effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. The pathologic interpretation of the tissue margins is done on site by the Mohs surgeon, who is specially trained in the reading of these slides and is best able to correlate any microscopic findings with the surgical site on the patient. Advantages of Mohs surgery include: 

• Ensuring complete cancer removal during surgery, virtually eliminating the chance of the cancer growing back
• Minimizing the amount of healthy tissue lost
• Maximizing the functional and cosmetic outcome resulting from surgery Repairing the site of the cancer the same day the cancer is removed, in most cases
• Curing skin cancer when other methods have failed

Other skin cancer treatment methods blindly estimate the amount of tissue to treat, which can result in the unnecessary removal of healthy skin tissue and tumor re-growth if any cancer is missed.

When assessing the cost-effectiveness of Mohs surgery there are several factors to consider. Because of the number of personnel involved as well as the advanced technology required, the initial procedure is often more costly than other treatment methods. However, because of the procedure’s high success rate, most patients require only a single surgery. This surgery usually includes the repair of the wound as well. While other methods might initially be less expensive than Mohs surgery, additional surgeries and pathology readings are required to repair the wound and to treat the cancer if it is not completely removed. Each of these additional surgeries and pathology readings will require separate fees, while a single Mohs surgery procedure includes all of these into one fee.

There are also human costs to be considered. Because Mohs surgery minimizes the amount of healthy tissue removed, it also reduces the impact to the surrounding area. The aesthetic outcome of the surgery is optimized. Furthermore, the psychological impact of being subjected to multiple procedures when cancer recurs can be significant. Patients usually find it reassuring to know that their cancer has been treated with a single procedure that gives them the highest possible chance of complete cure.

The Mohs procedure involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached (called clear margins). Because the Mohs College surgeon is specially trained as a cancer surgeon, pathologist, and reconstructive surgeon, Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%.

It’s helpful to know what to expect before you undergo any surgical procedure. Because the Mohs surgery procedure for skin cancer removal is somewhat complex, it can be reassuring to become familiar with the process ahead of time. While Mohs surgery is highly effective, it is an intricate skin cancer treatment that requires time and patience.

Surgeons usually perform Mohs micrographic surgery as an outpatient procedure in their office, which will have an on-site surgical suite and a laboratory for immediate preparation and microscopic examination of tissue. Typically, surgery starts early in the morning and is completed the same day, depending on the extent of the tumor and the amount of reconstruction necessary.

Local anesthesia is administered around the area of the tumor as the patient is awake during the entire procedure. The use of local anesthesia in Mohs surgery versus general anesthesia provides numerous benefits, including the prevention of lengthy recovery and possible side effects from general anesthesia. After the area has been numbed, the Mohs surgeon removes the visible tumor along with a thin layer of surrounding tissue. This tissue is prepared and put on slides by a technician and examined under a microscope by the Mohs surgeon. If there is evidence of cancer, another layer of tissue is taken from the area where the cancer was detected. This ensures that only cancerous tissue is removed during the procedure, minimizing the loss of healthy tissue. These steps are repeated until all samples are free of cancer. While there are always exceptions to the rule, most tumors require 1 to 3 stages for complete removal.

When the surgery is complete, the Mohs surgeon will assess the wound and discuss options for ideal functional and cosmetic reconstruction. If reconstruction is necessary, the Mohs surgeon will usually perform reconstructive surgery to repair the area the same day as the tumor removal.