Mohs Surgery

Mohs Micrographic Surgery is an advanced treatment for skin cancer performed by Mohs surgeons at the Annapolis Dermatology Center. Mohs surgery offers the highest cure rate while removing the least amount of normal tissue. The Mohs physician serves as the surgeon, pathologist and reconstructive surgeon. The process utilizes a microscope to trace out and ensure removal of the skin cancer’s roots. This procedure allows the physician to see beyond the visible disease and to precisely identify and remove the entire tumor, leaving healthy tissue intact and unharmed.

Clinical studies have shown that the cure rate for Mohs Micrographic Surgery is the highest of all treatments for previously untreated skin cancer – up to 99 percent, and up to 95 percent for recurrent skin cancers. As the most exact and precise method of tumor removal, this procedure minimizes the chance of recurrence and decreases the potential for scarring or disfigurement. As such, Mohs surgery offers the highest potential for complete removal of the cancer, while sparing the surrounding healthy tissue.

Your Surgery Day

On your day of surgery, check in at our surgical center on the second floor at your scheduled time. We will escort you to one of our procedure rooms and help you get comfortable. The Mohs surgeon will use injectable anesthesia to anesthetize the surgical site, just like when your dermatologist performed the biopsy. You will not be “put to sleep.”  The obvious cancer plus a 1-2mm margin of normal tissue will then be removed. The removal typically takes 15 minutes, and then a bandage is applied. The analysis of the tissue requires 1-2 hours. During this time, you can relax in our surgical waiting area. We have comfortable chairs, a big-screen TV, a microwave, and refrigerator for your convenience. If skin cancer is detected in the tissue margins, you will be escorted back into the procedure area and the process is repeated until all of the skin cancer is removed. Once the skin cancer is completely removed the reconstructive surgery is performed (same day).
 

The Procedure

Mohs Micrographic surgery includes a specific sequence of surgery and pathological investigation.  The Mohs surgeon examines the removed tissue for evidence of cancer cells.  Once the visible tumor is removed, the physician traces out the paths of the tumor using two key tools:

  • a map of the surgical site;
  • a microscope.

Once the obvious tumor is removed, the physician will:

  • removes an additional, thin layer of tissue from the tumor site;
  • creates a “map” or drawing of the removed tissue to be used as a guide to the precise location of any remaining cancer cells;
  • microscopically examines the removed tissue thoroughly to check for evidence of remaining cancer cells.

If any of the sections contain cancer cells, the physician will:

  • return to the specific area of residual tumor as indicated by the map;
  • remove another thin layer of tissue only from the specific area where cancer cells were detected;
  • microscopically examine the newly removed tissue for additional cancer cells.

If microscopic analysis still shows evidence of disease, the process continues, layer-by-layer, until the cancer is completely removed.

 

Indications

Mohs Micrographic Surgery is used primarily to treat basal and squamous cell carcinomas, but can also be used to treat less common tumors such as extramammary paget’s disease, sebaceous carcinoma, dermatofibrosarcoma pertuberans, atypical fibroxanthoma, and others.

Mohs surgery is indicated when:

  • the cancer is in a difficult area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, fingers, toes and genitals;
  • the cancer was treated previously and recurred;
  • the cancer is large;
  • the edges of the cancer cannot be clearly defined;
  • the cancer grows rapidly or uncontrollably;
  • scar tissue exists in the area of the cancer.

Reconstruction

The best method of managing the wound resulting from surgery is determined after the cancer is completely removed. Once the final defect is known, management is individualized to achieve the best results and to preserve functional capabilities and maximize aesthetics.  Our Mohs physicians have extensive training in reconstruction of all areas of the body including the face.  A small wound may be allowed to heal on its own, or the wound may be closed with sutures, a skin graft or a flap. On some occasions, another surgical specialist may complete the reconstruction as part of a team approach.