Mohs’ Micrographic Surgery is a highly specialized method of removing and examining cancerous tissue to ensure its removal. Frederic Mohs first invented this procedure, which is named after him. For the most common forms of skin cancer (basal cell carcinoma and squamous cell carcinoma), this procedure has the highest cure rate (least chance of the skin cancer growing back).
- The area is cleansed with alcohol.
- The visible tumor is identified and marked (usually with a purple gentian violet marking pen)
- The area is numbed using tiny needles and injecting a local anesthetic
- The area is prepped (cleansed) using Betadine® or Hibiclens® to reduce the risk of infection.
- The tumor itself is often removed using a curette (small sharp tool) or cut out using a scalpel.
- A small margin (usually < 1mm) of normal appearing skin is removed all around and underneath the area where the tumor was. This is called Stage 1. This skin is used for examination.
- The skin removed from Step 6 is inked for orientation purposes so that if there is any cancer remaining, the surgeon can go to the exact location where it remains to remove more tissue (which would beStage 2, etc.).
- The tissue is then frozen and cut and placed onto glass slides that will be stained.
- The slides are then examined by the surgeon to ensure that all of the cancer is out. If the cancer is not all out, the surgeon can locate the area on the patient where cancer remains by the dyes that were used for orientation purposes and take an additional stage (see steps 7-9).
- After all of the cancer is out, the wound can be left to heal by itself (without stitches) or closed using stitches.
Common misconceptions about Mohs’ Micrographic Surgery
About Robert S. Bader, M.D and his Mohs’ surgery training:
During his residency in Dermatology at MCP-Hahnemann University Hosptial, Dr. Bader had extensive training in Mohs’ Micrographic and reconstructive surgery. After residency, where he also served as Chief Resident, Dr. Bader completed a one-year fellowship in Mohs’ Micrographic Surgery and Dermatologic Plastic Surgery. Mohs’ Micrographic Surgery is only a method to remove a tumor. Following the removal of the tumor, Dr. Bader utilizes Plastic Surgery to recontruct the defect to leave the smallest possible scar. In fact, Dr. Bader is able to reconstruct 99% of the cases in the office immediately after Mohs’ Micrographic Surgery. In addition to the added convenience of having the procedure completed in one location on a single day in nearly all cases, one does not have to go to a hospital operating room or ambulatory surgery center, which can cost thousands of dollars.