The procedure is performed by specially trained surgeons who have completed at least one additional year of fellowship training (in addition to the physician’s three-year dermatology residency) under the tutelage of a Mohs College member.
Initially developed by Dr. Frederic E. Mohs, the Mohs procedure is a state-of-the-art treatment that had been continuously refined over 70 years. With the Mohs technique, 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.
Because the physician is specially trained in surgery, pathology, and reconstruction, Mohs surgery has the lowest recurrence rate of all treatments for skin cancer—as little as 1%. The Mohs technique is also the treatment of choice for cancers of the face and other sensitive areas as it relies on the accuracy of a microscopic surgical procedure to trace the edges of the cancer and ensure complete removal of all tumors down to the roots during the initial surgery.
How Mohs micrographic surgery works:
After obtaining local anesthesia, the visible portion of the tumor is removed:
- a thin “pancake like” layer of tissue is removed from the tumor site;
- a map or drawing is made of the removed tissue to be used as a guide to the precise location of any remaining cancer cells;
- the removed tissue is sectioned, thinly sliced, and then mounted on microscope slides for examination;
- the entire bottom surface and outside edges of the tissue section are thoroughly examined under the microscope to check for evidence of remaining cancer cells;
- if more tumor is found, its location is traced on the map so that only areas with remaining skin cancer undergo further surgery
If any of the sections contain cancer cells, Dr. Kolansky:
- uses the map to return to the specific area of the tumor site where skin cancer is still present;
- removes another thin layer of tissue only from the specific area within each section where cancer cells were detected;
- microscopically examines the newly removed tissue for additional cancer cells
If microscopic analysis still shows evidence of disease, the process continues layer-by-layer until the cancer is completely removed. When the removed tissue shows no sign of disease, the removal process stops. This aids in preserving or “saving” healthy, normal tissue. This technique ensures that all the diseased tissue—and only the diseased tissue—is removed. The importance of leaving as much normal, uninvolved skin as possible is readily appreciated
Of all treatments for skin cancer, Mohs micrographic surgery:
- Offers the lowest recurrence rate (typically 1%);
- Has the lowest chance of cancer re-growth;
- Examines all of the surgical margins;
- Spares the most normal skin in the tissue removal process;
- Minimizes the potential for scarring and disfigurement;
- Is the most exact and precise means of skin cancer removal;
- Cost effective, outpatient surgery utilizing local anesthesia
The Fellowship Training Difference
Only fellowship-trained ACMS members—like Dr. Kolansky—have received rigorous, hands-on direction and education from experienced practitioners of Mohs surgery.
- 1-2 years additional training post-residency
- Minimum 500 cases during training
- Exposure to rare tumor pathology, difficult tumor locations, and complex wound reconstruction
- Training programs must pass rigorous application and review process
What Skin Cancers Are Best Suited for Mohs Surgery?
Mohs micrographic surgery is most commonly used to treat basal and squamous cell carcinomas. Mohs surgery is the treatment choice when:
- The cancer is large;
- The edges of the cancer cannot be clearly defined;
- The cancer is in an area of the body where it is important to preserve healthy tissue for the maximum functional and cosmetic result, or is likely to recur if treated by methods other than Mohs
If the skin cancer involves the central face, eyelids, nose, ears, lips, cheeks and neck Recurrent skin cancer or prior treatments failed;
- The cancer has an aggressive appearance under the microscope such as morpheaform basal cell carcinoma or squamous cell carcinoma;
- The cancer is a known aggressive cancer such as: sebaceous carcinoma, dermatofibrosarcoma protuberans (DFSP), extramammary Paget’s Disease (EMPD), atypical fibroxanthoma (AFX), and others;
- The patient has a deficient immune system such as kidney or heart transplant patients;
- Patients concerned about obtaining the best cosmetic outcome
Is Mohs Micrographic Surgery for You?
Book a consultation with the fellowship trained Dr. Kolansky and begin to get help from the best.