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Mohs Micrographic Surgery

Read our Facial basal cell carcinoma publication in the BMJ (free)

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The aim of surgery is to completely remove skin cancer.

Mohs micrographic surgery is named after Dr. Fred Mohs who described it in 1941 and is a specialized procedure used to remove skin cancer. The procedure involves microscopic analysis and a map (graph = micrographic) of a tumour to ensure that all the skin cancer is completely removed. This gives the best chance of total eradication of the cancer and ultimately a cure from that skin cancer.

This is not a routine procedure but reserved for those tumours designated as being difficult, more aggressive, large, unusual, recurrent, previously incompletely removed or located at cosmetically sensitive or anatomically important sites.

Examples of Mohs Micrographic Surgery:

Pre-op

     
BCC on cheek   BCC extent marked out   Defect after 4 stages of Mohs surgery   Defect

Post-op

         
Closure   Post-op        

For most skin cancers, simply cutting out them out or curetting (scraping) them may be sufficient for complete removal depending on the site, size and sub-type of tumour.

Mohs surgery is a much more precise and accurate way of tumour removal. It offers immediate and complete histological examination of the surgical margins. No other treatment modality approaches the consistently high cures rates for non melanoma skin cancer (NMSC, such as BCC and SCC) offered by Mohs surgery. (ref.1)

Additionally, Mohs micrographic surgery spares normal tissue. Thus, it offers the highest cure rates and aims to create the smallest surgical wound which is advantageous because this offers the surgeon sometimes simpler or more reconstructive options than if a larger wound had been created.

5-year cure rate for primary BCC (ref. 2)

Mohs 99%
Excisional surgery 89.9%
Cryotherapy 92.5%
Curettage and cautery 92.3%
Radiotherapy 91.3%

Mohs micrographic surgery is cost effective (ref.3)

Reference

1. Otley CC. Non-melanoma skin cancer. Past Present and future. Curr Probl Dermatol March/ April 2001; 109-113.

2. Rowe DE, Carroll RJ, Day CL Jr. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol 1989; 15: 315–328.

3. Cook J, Zitelli JA. Mohs micrographic surgery: a cost analysis. J Am Acad Dermatol 1998; 39: 698-703.

Watch a video on Mohs surgery

Learn more about Mohs surgery

See Mohs surgery in picture

 

 
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