The Mohs Step-by-Step Process
The Mohs surgery procedure is a simple concept: remove the cancer, microscopically check to be sure there is no more cancer, then appropriately manage the wound. Our surgeons are fellowship trained members of the American College of Mohs Surgery who have experienced the complex nuances of this process for thousands of cases, treating a large variety of skin cancers. This page describes the steps they follow for each Mohs surgical procedure.
The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur. Surgery begins with the Mohs surgeon examining the visible lesion and planning what tissue to remove. The patient receives local anesthesia before the procedure starts.
The surgeon removes all visible tumor using careful surgical techniques and guided by experienced clinical judgment.
The Mohs surgeon next removes a deeper layer of skin, keeping precise orientation by making reference marks on the skin. The surgeon makes a map of the tumor specimen and color-codes the surgical specimen. Specially trained technicians immediately process the tissue, producing tissue slides for inspection by the Mohs surgeon.
In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer. 100% of the specimen edges are inspected (routine non-Mohs methods of tissue analysis involve inspection of less than 1/1000th of specimen edges).
If the surgeon finds cancer cells under the microscope, their location is marked on the map. Another excision is then performed precisely targeting where the cancer cells are mapped. Healthy skin and tissue are spared further surgery. Identical processing and comprehensive analysis is performed.
The removal process stops when there is no longer any evidence of cancer in the surgical site. Because Mohs surgery removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.
At this point, the surgeon discusses reconstruction options, should they be required, and post-operative care and expectations. Mohs surgery recovery tends to be easily manageable because of the use of local anesthesia and the careful surgical techniques.