Mohs Surgery

In the mid-1960s, while studying with Dr. Mohs, Dr. Perry Robins realized the surgery had great potential in dermatology. Dr. Robins was instrumental in developing a fellowship training program and promoting Mohs surgery worldwide.³

This series will present relevant topics to today's laboratorians practicing Mohs surgeries. Areas discussed will describe steps for practicing surgeries, provide thoughts on setting up a new laboratory and offer tips for completing a Mohs laboratory inspection.

Skin cancer is the most common cancer worldwide.⁴ Basal cell carcinoma and squamous cell carcinoma are the most prevalent skin cancers, and 80% of these cancers occur on the head and neck.⁵ Mohs surgery can treat these and treat dermatofibrosarcoma protuberans (DFSP), extramammary Paget's disease, Merkel cell carcinoma, and early melanomas.⁶

Mohs surgery is performed under a local anesthetic and near a laboratory by a specially trained surgeon – usually a dermatologist who has completed extensive surgical training in dermatopathology and reconstructive surgery. Mohs surgery is a staged procedure in which the Mohs surgeon removes a layer of the visible cancerous area, inks and maps the specimen, and microscopically assesses the sample while the patient waits. If cancer cells remain, the surgeon continues to remove layers from the affected areas until no further cancer cells exist. The surgeon can selectively remove only the areas where cancer remains, sparing unaffected tissue by inking and mapping. 

The benefits of Mohs surgery include: 

• Completed under local anesthesia, usually in an outpatient setting 
• Precise results - 100% of the tissue margins examined 
• Excellent rate of cure  
• Sparing of healthy tissue with little scarring 
• Cost-effective
• Usually completed in one procedure  

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