Mohs micrographic surgery is an advanced, effective procedure for treating skin cancer. With a success rate of up to 99 percent - the highest for all skin cancer treatments - this technique is frequently the treatment of choice for cancers of the face and other sensitive areas.
Using the Mohs procedure, physicians are able to see beyond the visible disease to precisely identify and remove the entire tumor layer by layer, while leaving the surrounding healthy tissue intact and unharmed. As the most exact and precise method of tumor removal, it minimizes the chance of re-growth and lessens the potential for scarring or disfigurement.
At CMC Cosmetic and Plastic Surgery, Dr. Briana Heniford specializes in the sophisticated Mohs procedure. Fellowship-trained at the Cleveland Clinic, Dr. Heniford brings experience and expertise to patient care. Unlike many Mohs-trained physicians (most whom are dermatologists), she is a board-certified head and neck surgeon with training in reconstructive techniques.
Mohs Surgery Procedure
The Mohs technique is usually an outpatient procedure performed at our office. Typically, the procedure begins early in the morning and is completed the same day, depending on the extent of the tumor and the amount of reconstruction necessary. Local anesthesia is administered around the tumor area and the patient is awake during the entire procedure.
Fractions of skin cancer may extend beyond the visible portion of the tumor. It is imperative that every trace of cancer is removed to ensure that the cancer will not return.
The Mohs process begins by surgically removing the visible portion of the tumor. A layer of skin is removed and divided into segments. Each segment is color coded with dyes, and reference marks are made on the skin to show the source of each segment. A map of the surgical site is then drawn.
The boundaries and undersurface of each segment are microscopically inspected to ensure no traces of remaining cancer exist.
If cancer cells are found under the microscope, their position is noted by the surgeon on the "map." The surgeon then returns to the patient to remove another layer of skin at the exact location of the remaining cancer cells.
It is through the repetition of Steps 3 and 4 that the ACMS surgeon is able to ensure that no cancer remains in the surgical site.
The removal process stops when there is no longer any evidence of cancer remaining in the surgical site. Because Mohs surgery removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.
Mohs Surgery Reconstruction: Repairing the Wound
As a result of Dr. Heniford's extensive reconstructive surgery training, she is often able to perform reconstructive surgery immediately after the microscopic analysis confirms that the cancer has been completely removed. Post-removal options will be discussed at the initial consultation, including whether the wound will be closed primarily or require a skin graft or flap.
Mohs Micrographic Surgery Post: Surgical Management
Post-surgical check-ups are recommended in order to monitor a patient's progress and find any possible cancer recurrences in a timely manner.
Since two out of five patients with one skin cancer will develop another within five years, follow up is extremely important for early detection of any new lesions. Follow-up often involves close collaboration with the patient's dermatologist.