• Dermatology Health Specialists 1693 SW Chandler Ave Ste 250, Bend, OR 97702
  • Hours: Mon - Fri: 8:00am - 5:00pm

Mohs micrographic surgery was originally developed in the 1930s and has been refined into the most advanced, precise and effective treatment for removing skin cancer. Mohs Surgery is a surgical technique that excises not only the visible tumor but also any microscopic cancer cells that may have extended beneath the skin surface.

Mohs surgery involves systematic removal and microscopic analysis of thin layers of tissue at the tumor site until the last traces of cancer have been eliminated. The immediate and complete microscopic examination and evaluation of excised tissue are what differentiates Mohs surgery from other skin cancer removal procedures. The cancerous tissue is removed with minimal normal tissue sacrifice, minimizing both post-operative wound size and chances of recurrence.

Mohs surgery is unique and effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. 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 qualified to correlate any microscopic findings with the surgical site on the patient. Advantages of Mohs surgery include:

  1. Ensuring complete cancer removal during surgery, minimizing the chance of cancer growing back.
  2. Minimizing the amount of healthy tissue lost.
  3. Maximizing the functional and cosmetic outcome resulting from surgery.
  4. Repairing the site of cancer the same day the cancer is removed, in most cases.
  5. Curing skin cancer when other methods have failed.

According to the National Comprehensive Cancer Network (NCCN) Guidelines, Mohs surgery is ideal for the elimination of skin cancers in cosmetically and functionally critical areas, such as head, neck, hands, shins, and feet. It is also used for tumors that have recurred or tumors that have indistinct borders where it is difficult to tell where the tumor margin ends. In patients that have a decreased immune system, Mohs surgery should be considered for all skin cancers, regardless of their location. Mohs surgery is also indicated for aggressive types of skin cancer.

However, there are some instances in which Mohs micrographic surgery, despite being shown to be the most cost-effective treatment modality for skin cancer, is not the best treatment option. In addition to the NCCN criteria listed above, the following should also be considered when determining how to best treat the patient:

  1. Age of the patient
  2. Living situation
  3. Comorbidities
  4. Symptoms of skin cancer

Based on these factors, the primary question is whether excisional surgical treatment would be beneficial to the patient. In some patients, further definitive surgery may have limited benefit to the patient’s overall health and other treatments such as electrodesiccation and curettage (EDC), topical immunomodulators, or doing nothing should be considered. However, there are some instances in these patients in which Mohs micrographic surgery would still be beneficial as many skin cancers can be painful, may get infected easily, and can bleed excessively, all of which can cause significant burden to the patient, their family, or the caregivers. As with all patients, cost-benefit analysis and discussion should be held with the patient and their family for a joint decision.

Mohs Fellowship Training

Upon completion of a one-year internship followed by a three-year dermatology residency, a dermatologist can apply to participate in a Micrographic Surgery & Dermatologic Oncology (Mohs) fellowship training program. Qualified applicants undergo an extremely competitive review and selection process to obtain a one-year fellowship position with a program accredited by the Accreditation Council for Graduate Medical Education. Once selected, fellows are trained through a structured curriculum that includes operative and non-operative treatments for skin cancer patients, and exposure to long-term results, recurrences, and complications. Ultimately, fellowship trained Mohs Surgeons are the most comprehensively trained physicians to care for patients with skin cancer or patients that are at risk for skin cancer.

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