Roger W. Altman MD FAAD is a dermatologist in Palm Harbor, Florida, who specializes in the practice of Mohs surgery. For more than 29 years, Dr. Altman has been providing skin cancer treatment to patients throughout Pinellas County.
What is Mohs Surgery?
In the early 1940s, Dr. Frederick Mohs, Professor of Surgery at the University of Wisconsin, developed a form of treatment for skin cancer, which he called chemosurgery. The technique has since come to be known as "Mohs surgery" in honor of Dr. Mohs.
Mohs surgery is a highly specialized treatment for the total removal of skin cancers, in which the microscope is used to determine the extent of the tumor and its location. The procedure has since been refined and improved upon, and today almost all cases are treated by the "fresh tissue" technique, which omits the chemical paste.
The surgery is performed as follows: The skin suspicious for cancer cells is treated with a local anesthetic so that there is no feeling of pain in the area. To remove most of the visible skin cancer, the tumor is scraped using a sharp instrument called a curette. A thin piece of tissue is then removed surgically around the scraped skin and carefully divided into pieces that will fit on a microscope slide.
Examination of Tissue
The edges are then marked with specially colored dyes, a careful map or diagram of the tissue removed is made, and the tissue is frozen by the technician. Thin slices can then be made from the frozen tissue and examined by the doctor under the microscope. Most bleeding is controlled using pressure and other routine measures, although, occasionally, a small blood vessel is encountered which must be tied using suture material.
A pressure dressing is then applied, and the patient is asked to wait while the slides are being processed. The physician then examines the slides under the microscope and is able to tell if any tumor is still present. If cancer cells remain, the doctor is able to determine the number of cells and their exact location.
Another layer of tissue is then surgically removed, and the procedure is repeated until the physician is satisfied that the entire base and sides of the wound have no cancer cells remaining. As well as ensuring total removal of the cancer, this process preserves as much normal, healthy, surrounding skin as possible.
Duration of Surgery
The removal of each layer of tissue takes approximately 1 to 2 hours. Only 20 to 30 minutes of that time is spent in the actual surgical procedure; the remaining time is required for slide preparation and interpretation. The removal of 2 to 3 layers of tissue, called "stages," is usually required to complete the surgery. Therefore, by beginning early in the morning, Mohs surgery is generally completed in 1 day. Sometimes, however, a tumor may be extensive enough to necessitate continuing surgery a second day.
Rate of Cure
In summary, by microscopically pinpointing areas involved with cancer and selectively removing these tissues, the Mohs surgeon can successfully remove your skin cancer. Using this technique, the percentage of success is very high, often 97% to 99%, even if other forms of treatment have failed. However, no one can guarantee a 100% cure.
Because normal tissue is preserved to the greatest extent possible, the Mohs surgeon is also able to offer you the possibility of a good cosmetic result, and every effort is made to minimize the scar.