Mohs surgery, also known as Mohs micrographic surgery, is a specialized surgical procedure used to treat certain types of skin cancer, particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). It is named after the surgeon who developed the technique, Dr. Frederic Mohs.

How Mohs Works:

1. Removal: The Mohs surgeon removes the visible tumor (indicated by the biopsy report) along with a thin 1 - 2 mm margin layer of surrounding tissue.

2. Microscopic Examination: The removed tissue is carefully mapped, and the Mohs surgeon examines the edges of the tumor under the microscopic in the in-house laboratory. This process takes anywhere between 1 — 2 hours and allows the surgeon to check if any cancer cells remain in the margins of the excised tissue.

3. Final Results: The removal and examination process is repeated layer by layer until no cancerous cells are detected at the margins. The wound is then repaired, or in certain scenarios, left to heal on its own.

One of the benefits of Mohs surgery is that the procedure preserves as much healthy tissue as possible, thereby minimizing scarring and reducing the risk of recurrence. Overall, it is a highly effective option for treating skin cancers; it is the current gold standard of care.

Some of the indications for Mohs surgery include the following:

1. High-Risk Cancers: Skin cancers located in areas where cosmetic appearance is important, such as the face, ears, nose, or around the eyes.

2. Large, Aggressive, or Recurrent Tumors: The procedure is particularly effective for skin cancers that have been previously treated in a variety of ways and come back.

3. Rare tumors: In additional the three common tumors for which Mohs surgery is used, such as squamous cell carcinoma, basal cell carcinoma, and melanoma, Mohs surgery can be used to treat rare tumors such as dermatofibrosarcoma protuberans and microcystic adnexal carcinoma.

4. Tumors in patients with a weakened immune system: Patients who are immunocompromised such as those taking immunosuppressive medications for an organ transplant are at a higher risk of skin cancer and these cancers tend to be more aggressive and harder to treat.

Mohs surgery has a high success rate because it checks for remaining cancerous cells immediately. The procedure is done in quick sessions, meaning patients undergo skin cancer removal and reconstruction on the same day.

Because minimized areas are removed in each stage, healthy tissue is preserved at a higher rate, resulting in less scarring compared to other forms of treatment.

In certain situations, Mohs surgery can be used to treat early stage melanoma that is confined to the skin’s outer layers, especially if the melanoma is located in a cosmetically sensitive area. Melanoma treated with Mohs surgery and the MART-1 immunostain, a special dye used to evaluate tissue margins, has a cure rate of up to 99%.

Dr. Terushkin’s repertoire includes surgical and pathological training for the treatment of melanoma using Mohs. He is the first Mohs surgeon in New York City to have treated melanoma with Mohs surgery and the MART-1 immunostain.

Although it is generally considered safe and effective, Mohs surgery carries some risk (as does any surgical procedure). The risks are relatively low:

• Infection: Because the skin is an external surface exposed to bacteria, there is a small risk of infection. Mohs surgeons use sterile techniques and give specific wound care instructions to reduce the risk of infection.

• Bleeding: The removal of tissue can lead to bleeding. Patients who take blood thinners may be more prone to bleeding. Please note that blood thinners are not stopped during the procedure.

• Scarring: Although Mohs is known to minimize scarring, any surgical procedure leaves a scar. See the next tab for more information about scarring.

• Pain or Discomfort: Though Mohs is generally well-tolerated, some pain or discomfort may occur. Local anesthesia is used during the procedure to numb the area, and post-procedure discomfort can be managed with Tylenol and/or Advil.

• Nerve Damage (Rare): If a skin cancer is located near a nerve, there is a small risk of nerve damage that could result in numbness, tingling, or muscle weakness. Mohs surgeons take care to avoid damaging nerves; most damage is temporary.

Overall, Mohs is a highly effective, safe, and minimally invasive procedure. The cure rate is 97 — 99%. The risks associated with Mohs are relatively low, but are still important to consider. Proper wound care can help minimize the risks and ensure the best possible outcome. If you have more concerns, please discuss with them with our team at the time of your appointment.

The approach to taking care of the wound depends on a number of factors, including the size of the wound, depth of the wound, location of the wound, and other patient characteristics. Some wounds are left to heal on their own while others can be closed in a line. Other times, we may need to borrow skin from another location to patch up the wound. That is called a skin graft. We are also trained to perform skin flaps, which means moving skin adjacent to the wound to cover up the wound. Finally, we sometimes work with other specialists to help close the wound.

As with any surgical procedure, Mohs surgery reconstruction will leave a scar. The extent of scarring depends on numbers factors. In some situations, the wound may take longer to heal than expected, especially if the skin cancer was large or located on the lower extremity.

Mohs surgery is the standard of treatment for the removal of skin cancers. The procedure has the highest cure rates, particularly with cancers with a high risk of recurrence or in difficult-to-treat or sensitive areas like the face.

The cure rate for Mohs is > 99% for new skin cancers and around 95% for recurrent cases.