What is Mohs Micrographic Surgery?
Mohs Micrographic Surgery or Mohs Surgery is a procedure named after the late Dr. Frederick E. Mohs, who developed the technique while working at the University of Wisconsin. Mohs Surgery is considered the “Gold Standard” of skin cancer treatment and produces the highest cure rates of any known cancer treatment. In its current form, the technique consists of two phases: cancer removal and microscopic examination.
Mohs Surgery differs from other forms of skin cancer surgery in that the dermatologist acts as both the surgeon when he removes the tumor and pathologist when he examines the tissue under the microscope. In the first phase of the procedure, a local anesthetic is injected into the area surrounding the skin cancer. Next, a circular incision is used to remove the skin cancer along with a small rim of normal tissue. The tissue is marked with special dyes and a map drawn to document its exact location on the patient. A temporary bandage is then placed on the wound while the tissue is sent for processing.
In the second phase, the removed tissue is taken to our laboratory and processed using a special ultra-thin cutting device known as a “cryostat.” Once this has been accomplished, the processed tissue is then ready for checking under the microscope. During microscopic examination, Dr. Fein checks the margins or “edges” of the tissue to confirm complete removal of the skin cancer. However if skin cancer is still present, a mark is made to the corresponding area on the Mohs’ map. A second piece of tissue is then removed from the patient and checked under the microscope. This process of tissue removal and microscopic checking is repeated until the cancer has been completely removed. Although it is difficult to predict, in our experience approximately half of the skin cancers we treat are removed in a single stage. Although several factors can affect the amount of time necessary to process the tissue, our goal is to have results within 1 hour.
Once the tumor has been completely removed, Dr. Fein will explain the various wound repair options which typically require sutures. In some instances, wounds can be allowed to heal on their own in a process known as “secondary intention.” Although Dr. Fein personally repairs more than 95% of the wounds following Mohs Surgery, he has a network with several outstanding plastic surgeons should the need for referral arise.
What conditions can be treated with Mohs Surgery?
Mohs Surgery is typically used to treat basal cell carcinoma and squamous cell carcinoma, the most common forms of skin cancer. Mohs Surgery has also been used successfully to treat other rare tumors such as dermatofibrosarcoma protuberans (DFSP) and lentigo maligna, a superficial form of melanoma.
Are all skin cancers treated with Mohs Surgery?
Although Mohs Micrographic Surgery is considered the “Gold Standard” of skin cancer treatment, producing the highest cure rates of any known cancer treatment, because of time and cost considerations its use has been recommended for the following situations:
- Skin cancer that recurs after a previous treatment
- Skin cancer involving “high risk” areas such as the nose, eyelids, lips, ears, and fingers
- Skin cancer with poorly defined borders or edges
- Skin cancer located on sites other than the face that are wider than 2 centimeters
- Skin cancer occurring in patients with compromised or weakened immune systems
- Skin cancer occurring in a patient under the age of 40
- Certain aggressive forms of skin cancer
How long does Mohs Surgery take?
Many factors influence the time necessary for surgery including the size, number, and location of the skin cancer. Recurrent skin cancers may prove larger than either the patient or dermatologist initially suspects. Although the time taken performing the surgery is only about 15 minutes per stage, the entire Mohs procedure on average lasts between 2 to 4 hours. Please keep in mind however that this is only an estimate and that in some instances it may take even longer.
What is the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO) and who can be a member?
The American College of Mohs Micrographic Surgery and Cutaneous Oncology or Mohs College is a national organization established in 1967 that is responsible for accrediting Mohs Surgery fellowship training programs. Currently there are approximately 50 accredited training programs in the United States.
Only physicians who have completed either a 1 or 2 year accredited fellowship program in Mohs Surgery are eligible to become Fellows of the ACMMSCO. During their training, physicians must complete a minimum of 500 procedures as well as demonstrate proficiency in pathology, histotechnology, and advanced surgical wound reconstruction.
What are the advantages of Mohs Surgery?
There are several advantages to the Mohs procedure including:
- Higher cure rates: in fact, cure rates as high as 99-100% have been reported for basal cell carcinoma treated with Mohs Surgery.
- Smaller scars: because of the special microscopic checking process, smaller amounts of normal skin are removed during the Mohs procedure than during a standard surgical excision. In fact despite removing less skin than a standard surgical excision, Mohs Surgery actually has a higher cure rate.
What are Dr. Fein’s credentials?
Dr. Fein is not only certified in dermatology by the American Board of Dermatology but has completed a 2-year accredited fellowship in Dermatologic and Mohs Micrographic Surgery at the Cleveland Clinic Foundation. Dr. Fein is an expert in the Mohs technique having completed nearly 1,200 Mohs procedures during his training. At the Cleveland Clinic, Dr. Fein had extensive personal training with Dr. Philip Bailin, an internationally regarded Mohs Surgeon and one of Dr. Frederick Mohs' original trainees. Dr. Fein is also an Associate Member of the American College of Mohs Micrographic Surgery and Cutaneous Oncology.