When you’re diagnosed with skin cancer, understanding your treatment options can feel overwhelming. Mohs surgery, also called Mohs micrographic surgery, offers the highest cure rate of any skin cancer treatment while preserving as much healthy tissue as possible. This specialized procedure is performed right in the office, and patients go home the same day with their skin cancer completely removed and the area repaired.
Joshua B. Eickstaedt, MD, FAAD, is a double board-certified dermatologist and fellowship-trained Mohs surgeon at Tryon Medical Partners’ SouthPark office. His work involves removing skin cancers via the Mohs technique, examining the tissue under a microscope, and reconstructing the surgical site to minimize visible scarring.
What is Mohs surgery?
Mohs surgery is a specialized treatment for skin cancer that was developed by Dr. Frederic Mohs. The Mohs surgery technique offers distinct advantages over other skin cancer removal methods.
“Mohs surgery is the gold standard in the treatment of skin cancer, because it offers the highest cure rate,” Dr. Eickstaedt explains.
What makes Mohs micrographic surgery unique is the immediate microscopic analysis of the tissue. During the procedure, the surgeon removes a thin layer of skin containing the cancer, then examines it under a microscope while the patient waits. If cancer cells remain at the edges, another thin layer is removed and examined. This process continues until no cancer cells are detected, hence the extremely high cure rate.
This precision approach means Mohs surgery “allows us to save the most amount of normal skin,” states Dr. Eickstaedt. “We keep the margins very narrow because we can confirm immediately where the cancerous skin stops and the healthy skin begins.”
What types of skin cancer does Mohs surgery treat?
Mohs surgery can treat various types of skin cancer, with some being more commonly treated with this technique than others.
- Basal cell skin cancer is the most common type of skin cancer and the most frequent reason patients undergo Mohs surgery. These cancers typically appear on sun-exposed areas and rarely spread to other parts of the body, but they can grow and cause significant damage to surrounding tissues (skin, cartilage, muscle, nerves) if left untreated.
- Squamous cell skin cancer is the second most common type of skin cancer. Like basal cell cancers, squamous cell cancers respond extremely well to Mohs surgery.
- Melanoma is the third most common skin cancer. While some melanomas may be more aggressive and require a multidisciplinary approach, early-stage melanomas in certain locations may be excellent candidates for Mohs surgery.
- Rare skin cancers like Merkel cell carcinoma can also be treated with Mohs surgery in some cases. These unusual cancers require a multidisciplinary approach involving Mohs surgeons, dermatologists, radiation oncologists, and medical oncologists.
“The vast majority of basal cell and squamous cell cancers are best served with Mohs surgery – that’s what I do 90% of the time. Basal is most common, followed by squamous,” Dr. Eickstaedt says.
Who is a good candidate for Mohs surgery?
“Any skin cancer can be treated with Mohs surgery,” Dr. Eickstaedt notes. “However, guidelines help determine the best approach for each patient.”
The ideal candidates for skin cancer surgery using the Mohs technique include:
- Patients with basal cell or squamous cell skin cancer in visible or functionally important areas, such as the face, head or neck, ears, hands, feet, or genitals – locations where preserving healthy tissue and minimizing scars matters most.
- Anyone with skin cancer that has come back after previous treatment. The precision of Mohs surgery makes it particularly effective for cancers that have been treated previously.
- People with large skin cancers or those with poorly defined borders. The microscopic examination during Mohs surgery ensures all cancer cells are removed, even when edges aren’t clearly visible.
- Patients with aggressive or rare forms of skin cancer that require the highest possible cure rate.
The process typically begins with your dermatologist or primary healthcare clinician who performs a biopsy to confirm skin cancer. If skin cancer is confirmed and surgical intervention is indicated, you’ll be referred to a Mohs surgeon.
What happens during Mohs surgery? Understanding the procedure
Many patients worry about what the treatment for skin cancer will involve. Understanding the Mohs surgery process can help ease those concerns.
- The procedure is performed in the office under a local anesthetic. Mohs surgery takes place in an office setting, so you don’t need to worry about hospital bills or the side effects of general anesthesia.
- For patients with anxiety, low levels of oral sedation can be provided. This mild sedation helps you stay relaxed while remaining awake during the procedure.
“During the procedure, the patient is awake, so I can talk with them,” Dr. Eickstaedt adds. “The conversational atmosphere helps patients feel comfortable.”
- You’ll be there for several hours. Unlike a biopsy that takes just minutes, Mohs surgery requires time for the removal of the skin cancer, microscopic examination, and the potential removal of additional layers. Usually, everything happens the same day and lasts 1.5 to 4 hours.
- The surgeon removes and examines the tissue. Mohs surgeons are dermatologists who are trained to evaluate the pathology of the removed cells. This specialized training allows for immediate analysis rather than waiting days for pathology results.
- The process repeats until the cancer is gone. If cancer cells remain at the edges of the removed tissue, another thin layer is taken from only that specific area. This continues until microscopic examination shows that all of the cancer has been removed.
- The wound is repaired the same day. Once all of the skin cancer is removed, the healthy skin is repaired with stitches or a graft. The type of closure depends on the location and the size of the area removed, with the goal to leave the least visible scar.
How does Mohs surgery compare to other skin cancer treatments?
While Mohs surgery is highly effective, it’s not the only treatment for skin cancer. Understanding your options helps you make an informed decision with your healthcare team.
The typical path for most patients is straightforward: patients see the dermatologist, who completes a biopsy, if it comes back positive for squamous or basal cell cancer, you are typically referred to a Mohs surgeon who removes it. Otherwise, patients will undergo a standard excision (complete surgical removal of tissue, organs, or a growth from the body) with their dermatologist, which involves removing the visible cancer plus a margin of healthy-looking skin, then sending the entire specimen to a pathology lab. Results for that type of excision typically take 7-10 days.
In contrast, Dr. Eickstaedt notes, “Patients are very satisfied with Mohs surgery, because I can tell them that day that the cancer will be completely removed.”
For advanced cancers, treatment becomes more complex. The whole team comes together to talk about what makes sense: options could include Mohs, then chemotherapy or radiation, or some combination of the available treatments. These cases often require several steps and a multidisciplinary care team: healthcare clinicians know the guidelines and discuss with other specialists what might be the best option for the patient in terms of the highest cure rate and the best cosmetic and functional outcome.
What are common misconceptions about Mohs surgery?
Several misunderstandings about Mohs surgery and skin cancer treatment can cause unnecessary worry.
Misconception: You’ll need to go to a hospital for surgery
Reality: Mohs surgery is performed in an office setting under a local anesthetic. There are no hospital bills, no general anesthesia, and none of the risks associated with being put under. It’s much more comparable to a dental procedure than to traditional surgery.
Misconception: You’ll need a plastic surgeon to repair the area
Reality: Mohs surgeons receive specialized training in reconstructive techniques.
“The doctor’s number one job is to remove all of the skin cancer. The next objective is to minimize the appearance of the scar. There will be a scar, but it’s my job to make sure no one notices it,” says Dr. Eickstaedt.
Misconception: It’s as quick as a biopsy
Reality: Patients should expect the Mohs procedure to last for several hours; a typical timeframe is between 1.5 to 4 hours long.
Misconception: Skin cancer isn’t that serious
Reality: Skin cancer is critically important to prevent and treat. Most basal and squamous cell skin cancers typically do not metastasize in the early stages. However, they still require prompt treatment to prevent significant local damage and spread into surrounding skin, cartilage, nerves, muscle, or bone. If these types of skin cancer are left untreated, they will continue to grow, cause pain and bleeding, and can cause serious damage.
“It’s best to treat all skin cancers when they are small to minimize disrupting normal structures and leaving the patient with a smaller, more optimized scar. If left untreated, there is a possibility of long-term damage or spreading through the body,” Dr. Eickstaedt cautions.
Why the comprehensive approach matters
What sets Mohs skin cancer surgery apart isn’t just the high cure rate; it’s the complete care provided in a single day by a highly trained specialist.
This comprehensive approach means your Mohs surgeon handles every aspect of your care: the cancer removal, the microscopic analysis to ensure complete removal, and the reconstructive work to minimize scarring. For patients, this translates to confidence that their cancer is gone before they leave the office, expert reconstruction by the same physician who understands exactly what was removed, and continuity of care from diagnosis through healing. If you have skin cancer and are interested in Mohs surgery, ask your dermatologist for a referral to a Mohs surgeon at Tryon Medical Partners.
