Mohs surgery, also known as chemosurgery, was developed by Dr. Frederic E. Mohs. Mohs Surgery is a microscopically controlled surgery that treats common types of skin cancer. Dr. Ginsburg first began performing Mohs surgery in 1999 at our Montclair office. Since then Dr. Ginsburg has performed thousands of Mohs procedures in Birmingham, Alabama. 

Removal of Skin Cancer

Mohs surgery is an effective method of obtaining complete control during the removal of skin cancer using frozen section histology. CCPDMA or Mohs surgery allows doctors to remove skin cancer with a very narrow surgical margin and a high cure rate. (CCPDMA – complete circumferential peripheral and deep margin assessment.)

Mohs Surgery Sure Rates

The cure rate with Mohs surgery is very high. Most studies cite the cure rate as between 97% and 99.8% for primary basal cell carcinoma, the most common type of skin cancer. Doctors use the Mohs procedure to treat squamous cell carcinoma, but it has a lower cure rate. Two isolated studies reported a cure rates for primary basal cell carcinoma as low as 95% and 96%. Recurrent basal cell cancer has a lower cure rate with Mohs surgery, more in the range of 94%. 

During the surgery, after the removal of tissue, Dr. Ginsburg examines the tissue specimen for cancer cells. That examination informs him where to remove tissue next. Dr. Ginsburg is performing the procedure and he is also the pathologist reading the specimen slides.

Mohs surgery is one of the many methods of obtaining complete margin control during removal of skin cancer (CCPDMA – complete circumferential peripheral and deep margin assessment) using frozen section histology. Asa result, CCPDMA or Mohs surgery allows for the removal of skin cancer with a very narrow surgical margin and a high cure rate.

The Procedure

A physician’s will often perform this procedure under local anesthetic. The doctor will use a small scalpel to cut around the visible tumor. A very small surgical margin is utilized, usually with 1 to 1.5 mm of “free margin” or uninvolved skin. This is much less than the usual 4 to 6 mm required for the standard excision of skin cancers. It is then cut on the cryostat, placed on slides, and stained with H&E. Then, the Mohs surgeon/pathologist examines the sections for cancerous cells and marks them. Finally, the surgeon removes the indicated cancerous tissue from the patient. The patient will undergo this procedure until there is no more cancer. 

Mohs surgery is done on an outpatient basis in an operating room or procedure room that has a nearby laboratory that allows the surgeon to examine the tissue after it’s removed. In most cases, the procedure lasts about four hours. But since it can be difficult to tell how extensive a skin tumor is just by looking at its surface, doctors often advise reserving the whole day for the procedure.

Other Treatment Options

There are many other acceptable skin cancer treatment options including freezing (cryosurgery), scraping & burning, surgical removal (excision), and laser surgery, which all require the surgeon to estimate how extensively to treat the area around the tumor. There are many advantages to Mohs surgery compared to other skin cancer treatments including its high cure rate and cost-effectiveness. Where preserving cosmetic appearance and function is important, this treatment is successful for skin cancers in such areas. If the tumor recurs, is located in scar tissue, is large, has ill-defined edges, and/or grows rapidly, a patient should consider this option.

Doctors examine the removed tissue under a microscope, and due to this, Mohs surgery is unique and effective. Doctors evaluate 100% of the surgical margins. A Mohs surgeon performs a pathologic interpretation of the tissue margins on site. Mohs surgeons train specifically to read slides and correlate any microscopic findings with the surgical site on the patient.

Advantages of Mohs surgery include:

  • Ensuring complete cancer removal during surgery
  • Virtually eliminating the chance of the cancer growing back,
  • Minimizing the amount of healthy tissue lost
  • Maximizing the functional and cosmetic outcome resulting from surgery
  • Repairing the site of the cancer the same day 
  • Curing skin cancer when other methods have failed.

In addition, other skin cancer treatment methods blindly estimate the amount of tissue to treat.  This often results in the unnecessary removal of healthy skin tissue and tumor re-growth due to missed cancer.

Screening for Skin Cancer is an important step in prevention. Learn how to identify different skin cancers.