Mohs Micrographic Surgery is a technique whereby skin cancers are treated by completely removing them under microscopic control. It offers the highest cure rate of all skin cancer treatments. However, because of its complexity, Mohs surgery is usually only used to treat cancers in areas where tissue conservation is critical, recurrent cancers, or difficult to treat cancers.

This surgery is performed in the office operating room. Mohs surgery is performed as follows:

A local anesthetic is injected to numb the area to be treated. The visible cancer is then surgically removed. In the area under and around the tumor, a thin layer of normal appearing tissue is removed and cut into small pieces. The pieces are mapped and color coded. This and all succeeding layers of tissue are taken out the same way to find and remove the roots of the cancer. To remember exactly where each piece of tissue came from, the doctor draws a map corresponding exactly to the wound he has created and the tissue he has color coded. The tissue is then brought into an adjoining lab where the technician makes frozen section slices of the entire margin. These slices, when viewed under the microscope, allow the doctor to examine the entire base and periphery of the tissue. If any cancer remains at any margin, the doctor is able to mark its exact location on the map. The patient is then brought back into the operating room where the doctor removes a second thin layer of tissue under and around the remaining cancer, examining it in the manner previously described. The process continues until the entire tumor has been removed.

Once a cancer-free layer of tissue has been reached, the Mohs surgery is complete. The number of stages or layers that must be taken from any individual is variable and depends upon the size and depth of the cancer. On average, most patients have two or three stages performed with each stage taking about one hour to process in the lab.

Once Mohs surgery is complete, the doctor must decide how the wound should be treated. Sometimes reconstructive surgery is necessary to obtain the best possible cosmetic and functional result. Usually the doctor will close the wound by moving adjacent skin, called a flap, or distant skin, called a graft. Usually this is done the same day as the Mohs surgery. Depending upon the size and location, the doctor may feel it is best to let the wound heal on its own, or to delay reconstruction.

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