What Is Mohs Micrographic Surgery?

Mohs surgery is a surgical cancer treatment technique that gives dermatologists the ability to remove skin cancers, layer by layer, until there are "clean margins" and no cancerous cells remain. A dermatologist trained in Mohs surgery will examine each layer of tissue under a microscope and look for evidence of cancer and will continue to excise thin layers until no cancerous cells are detected. A diagnosis of skin cancer can be devastating, but patients in Calabasas can choose Mohs micrographic surgery, the most advanced, precise and effective treatment for skin cancer types like basal cell carcinoma and squamous cell carcinoma.  Mohs surgery can also be utilized in the case of melanoma. Unlike standard excisions done under general anesthesia that remove not only the cancerous tissue, but also some adjoining healthy tissue, Mohs is an outpatient procedure that uses local anesthesia and removes skin cancer while reducing damage to nearby healthy tissue.

The Benefits of Mohs Surgery

During Mohs, Dr. Weitzbuch removes one thin layer of cancerous skin at a time, mapping, color-coding and microscopically examining each layer until all of the cancerous skin is gone. The ability to look at each affected skin layer, with 100% margin control, increases a patient's chance of remission and lowers the risk of future recurrence. Mohs micrographic surgery is an excellent treatment option for cancers of the skin with aggressive tendencies, a high recurrence risk, a large size, difficult-to-define borders and locations where preserving healthy tissue is key for preserving function. With Mohs, the surgeon can ensure the entire tumor is removed before repairing the skin. Therefore, this surgical technique boasts the highest complex skin cancer cure rate along with minimal normal tissue removal. Statistically, 95 percent of recurrent skin cancers and nearly 99 percent of new cancers are cured via Mohs micrographic surgery. This is in contrast to typical excisions where a smaller percent of tissue margins is examined later, causing a higher risk of missed residual tumors or necessitating more procedures. Additionally, the local anesthesia used during Mohs carries less risk than standard surgery under general anesthesia.

The Procedure: Step-by-Step

First, local anesthesia is applied to the site. Once the skin tissue is numb, Dr. Weitzbuch may use a scoop-shaped curette to gently scrape the tumor, which allows him to determine the margin between healthy tissue and cancerous cells. Then, Dr. Weitzbuch will excise the clinically apparent skin cancer, with a small margin of healthy appearing skin around it. After the first tissue layer is excised, a map of the tissue and its location in relation to nearby body landmarks is created. This map guides the surgeon to the tumor's exact location. Labels and color codes are applied to the tissue, correlating its place on the drawing. Finally, the patient is bandaged and permitted to leave the operating area. After the slide is processed by a technician here in the office, Dr. Weitzbuch will study each layer of tissue to determine if any cancerous cells remain. The process takes roughly one hour per stage. Depending on the complexity of the skin cancer, there may still be cancerous cells at the tissue margin, requiring additional surgical stages until all of the affected cells are gone. If more stages are necessary, Dr. Weitzbuch will review the map, excise another layer of tissue, and examine the tissue for lingering cancerous cells. Once all of the cancer is removed, Dr. Weitzbuch can reconstruct the surgery site for function and aesthetic purposes, using plastic surgery techniques. We offer an individualized approach, and depending on the wound, Dr. Weitzbuch may let the area healon its own, close it with stitches, graft it or perform a flap, or send the patient to a trusted specialist in certain cases. Patients are seen post-operatively to ensure proper healing and should be followed at least every 6 months tocheck for new aberrant skin growths.

Click here to learn more about the advantages of Mohs surgery for individuals with high risk non-melanoma and why it is skin cancer specialists preferred treatment method for delicate areas of the face and skin.

Frequently Asked Questions

  • QWhat Types Of Cancer Can Be Treated With Mohs Micrographic Surgery?

    Mohs surgery offers the highest cure rate among skin cancer treatments and it is effective on almost any basal cell and squamous cell carcinoma; however, Mohs is especially appropriate for:

    • Skin cancers on the face where the cosmetic result is functionally important.
    • Aggressive skin cancers that grow very quickly or have recurred after other treatments.
    • Large skin cancers with ill-defined margins.
  • QHow Is Mohs Micrographic Surgery Performed?

    Mohs surgery is performed right in the Calabasas Dermatology Center  in our surgical suites. The area to be treated is numbed with a local anesthetic. Dr. Weitzbuch  will first remove the visible portions of the lesion or tumor with a small margin and will examine them under the microscope. Then he will remove a thin layer of tissue surrounding the tissue margins and examine them, as well. This process will continue until the dermatologist is certain all evidence of cancer has been removed. Because each tumor is different, it is impossible to know in advance how long your surgery will take. Some may take an hour or two, others may take all day. Dr. Weitzbuch is also specially trained in plastic surgery closure techniques and is able to close the remaining defect after removal of all tumor cells, allowing for superior cosmetic results.

  • QWhat Are The Advantages Of Mohs Micrographic Surgery?

    In addition to the highest cure rate, Mohs surgery offers superior cosmetic results since repair and reconstruction occur immediately following the surgery. Mohs surgery also allows the dermatologist to preserve more healthy tissue than other treatment methods. While it is sometimes a longer procedure, the patient will leave our office knowing that their cancer is gone.

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Calabasas Dermatology Center
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Calabasas, CA 91302
City Winner of Calabasas Doctors Choice Awards in Dermatology 2014