Who Needs Mohs Micrographic Surgery?
March 11, 2025
Mohs surgery is a surgical technique used to remove skin cancer cells instead of non-cancerous tissue. The micrographic approach is a tissue-sparing, precise method of skin cancer removal named in honor of Fredrick Mohs, the surgeon who developed the technique in the 1930s. Originally called chemosurgery, the technique involved the application of astringent zinc chloride to the in-situ tumor. After 24 hours, the tumor was excised and microscopically examined. Mohs repeated the process with precise control to maximize conservation of healthy skin tissue.
“Mohs micrographic surgery is particularly suitable for skin cancer removal from functional and sensitive locations like the genitalia, areola, hands, feet, and nails,” explains Dr. Michael Steppie Orlando Mohs cancer surgeon and medical director of Associates in Dermatology. “Due to its precision, it is the Gold Standard for improved aesthetics for tumor removal from central facial areas, such as eyelids, eyebrows, nose, lips, chin, ears, and periauricular areas.”
This precise surgical procedure involves removing thin layers of skin incrementally until all cancerous cells are eliminated. Mohs ensures a minimal removal of healthy tissue and results in smaller scars. Moreover, apart from the initial injection of an anesthetic to numb the area of skin before surgery, patients typically experience little to no pain. Post-surgery care includes avoiding sweaty activities and showering is usually safe after 24 to 48 hours, as long as the wound dressing is replaced afterwards with a non-stick, petroleum gauze dressing.
This month the Skin Cancer Foundation’s March Newsletter is shining the spotlight on what people need to know about treating basal cell carcinomas, squamous cell carcinomas and certain melanomas using Mohs surgery. This micrographic surgical procedure has excellent cure rates up to 99% and is the most effective for removing non-melanoma skin cancers. It is especially useful in treating cosmetically challenging lesions on the head, face and neck, as well as other sensitive areas. Click here for even more facts about Mohs.
Why is a Moh’s surgery scar lengthy?
Although the Mohs surgeon determines how large a surgical incision they will need to make, a recent report published in JAMA Network Open suggests that most patients greatly underestimate the extended diameter of the actual incision by more than half the size. This is primarily due to the surgeon’s need to extend the incision, so the skin will lie flat when the surgical edges are closed. Based on the circumstances, the surgical wound may be left open to heal but is often closed in linear fashion using stitches that do not need to be removed manually and will dissolve over the coming weeks. However, proper wound care, such as avoiding UV exposure, helps to optimize healing and a pressure dressing may be used to reduce discomfort while protecting the wound from contamination.
Advantages of Mohs Micrographic Surgery
Mohs micrographic surgery has several advantages, including minimal scarring and precise removal of cancerous tissue. This tissue-sparing method of skin cancer removal is the most precise approach to tumor removal and has a cure rate of up to 99% for new cancers and 95% for recurrent cancers. The most obvious advantage is that it offers precise microscopic control of the entire tumor margin while optimizing conservation of healthy tissue. The use of Mohs surgery on specific tumors is discussed below:
- Mohs Surgery for Basal Cell Carcinoma – Most basal cell carcinomas can be treated and cured when detected early, but prompt treatment is vital as the tumor can become more dangerous as it grows. Plus, rarer and more aggressive forms can be disfiguring or even fatal. Mohs surgery is the most effective technique for removing BCCs, harming minimal healthy tissue while achieving the highest possible cure rate of up to 99 percent on tumors treated for the first time. Mohs surgery is the gold standard for large, aggressive or rapidly growing BCCs, as well as tumors that have returned and ones with indistinct edges. The wound may be closed with stitches, or in some cases, allowed to heal on its own.
- Mohs Surgery for Squamous Cell Carcinoma – Mohs surgery is a highly effective surgical procedure used to treat squamous cell carcinoma, a common type of skin cancer. It allows for the precise removal of cancerous tissue while minimizing damage to healthy surrounding areas. The Mohs surgeon numbs the affected area with local anesthetic before removing thin layers of tissue one-layer at a time. Each layer is examined under a microscope to determine remaining cancerous squamous cells until all the cancerous tissue has been extracted. Sutures or stitches are normally used to close the wound. Good news is Mohs surgery has a very high cure rate for squamous cell carcinomas.
- Mohs Surgery for Early Stage Melanoma – Since a Mohs surgeon removes the cancerous tumor and a thin layer of healthy skin tissue, this technique is extremely effective for early-stage melanoma on the face, ears or scalp. If melanoma cancer cells are still present as each layer of tissue is examined under a microscope, the surgeon will remove another layer of skin until no cancer cells remain. The size of the incision depends on the size and depth of the tumor and the actual location of the cancerous tissue removed. You may need to limit activities like swimming or a sweaty exercise routine until after your follow-up appointment, but can usually return to normal activities the next day.
- Mohs Surgery for Merkel Cell Carcinoma – Mohs surgery is an effective treatment option for Merkel cell carcinoma in sensitive areas of the face, head and neck. Micrographic surgery provides precision in removing cancerous sensory cells in the deepest areas of the skin. It helps minimize the risk of recurrence while preserving cosmetic appearance. However, the choice of surgical method often depends on the tumor's size and location, as a wider local excision may be the preferred approach. That said, research indicates that Mohs micrographic surgery can provide better outcomes for early-stage MCC. For cases where there's concern about the cancer spreading to nearby lymph nodes, a biopsy may be needed.
“Carcinoma and melanoma cancers result from abnormal skin cell growth,” adds Orlando dermatologist Michael Steppie, M.D.. “But, they differ significantly in severity and behavior. Carcinoma occurs in epithelial tissue in the skin and accounts for 80 to 90 percent of skin cancer cases. Melanoma occurs in melanocyte cells that give skin its color. Although mostly located in outer layers of skin, melanoma is generally more aggressive and is a higher risk to one's health.”
Is Mohs Surgery Better Than Radiotherapy?
Radiotherapy is an effective treatment option for removal of certain skin cancer tumors that utilizes powerful energy beams, such as image-guided x-rays or proton radiation, to target and destroy cancer cells. It can also be employed in various stages of treatment from early diagnosis to cases where the cancer may have already spread. Radiation can also be used as a neoadjuvant therapy to shrink tumors before surgery. Fractionated radiotherapy involves administering small doses over time to minimize side effects, while short-course radiation is often effective for superficial skin cancers.
“Mohs surgery is the preferred treatment for many skin cancer removals due to its high cure rates and effectiveness in completely removing cancerous tissues from sensitive locations,” adds Dr. Steppie. “This can result in a lower recurrence rate compared to the less precise tissue removal with radiotherapy.” While radiation therapy is non-invasive and doesn’t require post-surgical incisions or sutures, Mohs micrographic surgery tends to be more successful in treating the most common skin cancers like basal cell and squamous cell carcinomas. Although less common, melanoma is nonetheless considered much more dangerous due to its potential to spread.
Another advantage of Mohs micrographic surgery is that it is typically completed in a single-day visit, while radiotherapy requires multiple sessions, often five days a week for several weeks. Plus, according to the National Health Service (NHS) in Great Britain, many patients undergoing radiotherapy report fatigue, which may begin during treatment and persist until it is completed, sometimes making everyday activities more exhausting. For skin cancers in delicate areas like the face, Mohs surgery can offer better cosmetic outcomes thanks to its unique method of precise tissue removal.
______________________
Ultimately, the best treatment option for skin cancer removal depends on factors such as the cancer’s location, the patient’s health, and their preference for a less invasive approach. Since early detection can be crucial for the successful treatment of certain types of skin cancer, make your appointment online or call 800-877-7546 to schedule an exam with a dermatologist at one of our sixteen Central Florida offices in Orlando, Altamonte Springs, Apopka, Celebration, Clermont, Davenport, Dr. Philips, Hunter's Creek, Kissimmee, Mount Dora, Ocoee, Poinciana, Sanford, or St. Cloud.
