Mohs micrographic surgery for nonmelanoma skin cancer

Surgery Overview

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Mohs micrographic surgery involves removing a skin cancer one layer at a time and examining these layers under a microscope immediately after they are removed. This procedure allows for a close examination of each layer of skin to detect cancer cells. It also allows a minimal amount of tissue to be removed while ensuring complete removal of all the cancer cells.

A local anesthetic is injected into the skin before the surgery. Your doctor then begins to remove the skin cancer and a small amount of healthy tissue, one layer of skin at a time. Each tissue layer is prepared and examined under the microscope for cancer cells. Surgery is complete when no more cancer cells are detected.

What To Expect After Surgery

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Recovery may take 2 to 4 weeks, depending on the extent of surgery.

Why It Is Done

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Mohs micrographic surgery may be used for removal of skin cancer that:

• Is likely to return. Mohs micrographic surgery is more effective in obtaining cancer-free margins for cancers that have irregular borders and a history of removal and recurrence.
• Is located in visible areas or areas where skin tissue should be preserved, such as on the ears, nose, or eyelids.
• Is growing quickly.
• Has a high risk of spreading to other parts of the body, such as in some squamous cell carcinomas.
• Occurs in children.

How Well It Works

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Mohs micrographic surgery can be an effective treatment for skin cancer. This technique preserves as much nearby healthy skin as possible. Treatment with Mohs surgery offers the highest rates of cure for patients with squamous cell carcinoma.¹ Mohs surgery has a cure rate of over 95% for basal cell skin cancer and over 92% for squamous cell skin cancer.^{2, 3} Compared to other excision treatments, recurrence is less after Mohs micrographic surgery.

Risks

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Risks of surgery include:

• Infection of the wound.
• Scarring.
• Discomfort or pain.
• Bleeding.

What To Think About

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Mohs micrographic surgery is the best procedure to preserve skin tissue surrounding the cancer. However, it requires special training and equipment, and is time-consuming and expensive.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. National Cancer Institute (2005). Skin Cancer (PDQ): Treatment. Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/skin/healthprofessional/allpages.

2. Carucci JA, Leffell DJ (2003). Basal cell carcinoma. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., pp. 747–754. New York: McGraw-Hill.

3. Grossman D, Leffell DJ (2003). Squamous cell carcinoma. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., pp. 737–747. New York: McGraw-Hill.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Patrice Burgess, MD - Family Medicine
Specialist Medical Reviewer	Alexander H. Murray, MD, FRCPC - Dermatology
Last Updated	November 22, 2006