Mohs Micrographic Surgery

Mohs’ micrographic surgery (MMS) technique is best described through illustration and photography. This method identifies 100% or close to 100% of the margin both peripheral and deep as opposed to a standard excision that look at 3-5% of the margin. The most important concept to grasp is this: Mohs surgery is a specialized way of processing the tissue to look at 100% of tumor margin; it is the way we process and look at tissue that defines Mohs surgery.

The technique involves not only a fellowship trained Mohs surgeon, but also a well-equipped Mohs lab complete with a cryostat and tissue staining abilities.

The Mohs tissue processing method allows 100% of the resection margins to be examined microscopically. Areas of cancer found with the microscopic examination are located on maps, drawn both on paper and on the tissue itself. This way a re-excision was performed only where residual tumor is located and spares normal tissue. The excised tissue is frozen and sectioned horizontally; then read along with the graphical mapping to insure correct orientation.

The most significant advantage to Mohs Surgery is its extremely high success rate. Unfortunately, all surgical procedures carry the risk of scarring, and Mohs surgery is no different. However, the dermatologist performing Mohs surgery can utilize multiple methods to further prevent visible scarring to the affected area. The most common approach is for the surgeon to simply integrate stitching into natural skin crevices or out-of-sight areas, such as underneath the jaw line. This can be embellished using a “skin-flap” to shift the unsightly skin into one of these hidden places. It is important to note that the size and location of the tumor heavily influences scarring potential. The procedure itself is designed to minimize tissue excised due to the small surgical margin of one millimeter, therefore naturally leading to less scarring.