Mohs Surgery

History of Mohs

Mohs Surgery

In the early 1940's, Dr. Frederick Mohs, Professor of Surgery at the University of Wisconsin, developed a form of treatment for skin cancer he called chemosurgery. The word "chemosurgery" is derived from the words "chemical" and "surgery". The addition of "Mohs" honors the doctor who developed the technique. It is a highly specialized form of treatment for the total removal of skin cancers. It is performed by a team of medical personnel, which includes physicians, nurses, and technicians.

Mohs Surgical Team

Dr. Thomas, who heads the team, has had subspecialty surgical training during his fellowship in Mohs surgery at the University of Michigan and he is recognized as a Fellow by the American College of Mohs Surgery. Other physicians on the "team" may include fellows and residents who assist while learning the technique. The nurse is an important part of the team who will help answer your questions, respond to your anxieties, assist in surgery and instruct you in dressings and wound care after the surgery is performed. A technician, whom you may not meet, performs the essential task of preparing the tissue slides, which are examined under a microscope by the Mohs surgeon.

Mohs Procedure, what the patient should expect

The surgery is performed as follows: the skin suspicious for cancer 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. The wound is inspected after removal of the specimen and any bleeding that is encountered will be stopped by one of several methods; direct pressure, electrocautery (electric needle) and 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 prepared.

Tissue in the lab

Processing the specimen demands maintaining precise orientation of the specimen as it relates to the patient. The specimen is carefully divided into pieces that will fit onto a microscope slide; the edges are marked with colored dyes; a careful map or diagram of the tissue removed is made; and the tissue is embedded in a suitable medium (OCT) and frozen by the technician. Thin slices can then be made from the frozen tissue, stained and then examined by Dr. Thomas at the microscope. The removal of each layer of tissue, its processing in the lab as well as the microscopic assessment by Dr. Thomas takes approximately one hour.

After skin cancer removed

At the end of Mohs Surgery, you will be left with a surgical wound. This wound will be dealt with in one of several ways. The several options will be discussed with you in order to provide the best possible functional and cosmetic results

The possibilities explained below include: (1) healing by spontaneous healing (second intention); (2) closing the wound, or part of the wound, with stitches; (3) using a skin graft; (4) using a skin flap; or (5) arranging a consultation with a plastic surgeon who specializes in more complicated surgical repairs.

Visit the Mohs College website to learn more.