Articles - Mohs Micrographic Surgery

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Who Knows about Mohs?
Micrographic Surgery

"…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. "

Chadd Sukut, MD 
Advanced Dermatology & Skin Surgery
Board Certified Dermatologist, FAAD, FACMS

Chadd Sukut, MD

Mohs micrographic surgery is the most effective treatment for most types of skin cancer. It was initially developed in the 1930s by Fredrick Mohs, a physician at the University of Wisconsin-Madison.  Mohs micrographic surgery has been refined over the years into the most innovative, precise, and effective treatment for a growing variety of skin cancer types. With the Mohs technique, physicians can precisely identify and remove an entire cancerous tumor while maximizing preservation of healthy tissue.

The American College of Mohs Surgery (ACMS) is the only organization that requires its members to have successfully completed an extensive fellowship that requires at least one full year of training and hands-on experience provided by highly qualified instructors after completing their years of dermatology residency training. If you want your skin cancer treated with the highest standards of quality and competency, then Mohs micrographic surgery performed by an ACMS fellowship-trained dermatologic surgeon is the way to go.  We have three ACMS fellowship-trained surgeons at Advanced Dermatology, the only in Coeur d’Alene.

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 (also known as “clear margins”). Because the ACMS 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%.

Mohs surgery is unique and so effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. 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.  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 findings under the microscope with the surgical site on the patient.  Yes, the surgeon actually looks at the tissue underneath the microscope his or herself!

There are several advantages of Mohs Surgery.  Mohs surgery ensures complete cancer removal, practically eliminating the chance of the cancer growing back.  It minimizes the amount of healthy tissue lost (also known as “tissue sparing”).  It maximizes the functional and cosmetic outcome.  Moreover, the site of the cancer is usually repaired the same day the cancer is removed.  Lastly, Mohs surgery can cure skin cancer when other methods have failed.

Mohs Surgery is cost-effective.  Because of Mohs surgery's high cure rate, most patients require only a single surgery. This surgery usually includes the repair of the wound as well. Other methods might require additional surgeries and pathology readings in order to repair the wound and to treat the cancer if it is not completely removed. Each of these additional surgeries and pathology readings require separate fees, while a single Mohs surgery procedure includes all of these into one fee.  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.  Because the process of Mohs surgery minimizes the risk of recurrence, it reduces and frequently eliminates the costs of larger, more serious surgeries for recurrent skin cancers.  Now you know about Mohs.

By Chadd Sukut, MD