John D. Boyer, M.D. Mohs Micorgraphic Surgery and Skin Cancer Clinic
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American College of Mohs Micrographic Surgery

Mohs Micrographic Surgery

What is Mohs Surgery?

Mohs micrographic surgery is the most advanced, accurate and highly specialized treatment for the total removal of skin cancer. Mohs surgery is named in honor of Dr. Frederick Mohs, the physician who developed the technique at the University of Wisconsin in 1936.

The Mohs method of skin cancer treatment is unique because it is the only technique that provides the use of complete microscopic examination of all the tissues removed surgically, while simultaneously providing detailed graphic mapping techniques for orientation purposes. Precise microscopic mapping permits tracking of “roots” or extensions of tumor, thus the term micrographic surgery.

Published cure rates for Mohs micrographic surgery range up to 99% for previously untreated cancers. Mohs surgery is also the treatment of choice for cancers that have failed prior treatment. Because the microscope guides the surgery, the most amount of normal skin is spared without compromising cure. This sparing of normal tissue can greatly simplify reconstruction, maximize the preservation of normal skin and function, and save costs.

How is Mohs surgery performed?

1. The extent of a skin cancer cannot be determined by surface appearance alone. “Roots” of cancer may extend in random directions that are invisible to the naked eye. Graphic 1

2. The first step of Mohs surgery is to remove a thin layer of skin around the visible portion of the cancer and to precisely map its location. Graphic 2

3. The tissue is microscopically examined for evidence of residual cancer and, if present, more tissue is removed using the map as a guide. Graphic 3

4. The process is repeated until all cancer is removed. Cancerous skin is targeted, while healthy, cancer-free skin is spared. Graphic 4

What is the difference between Mohs and Standard Surgery?

Mohs surgery differs from all other methods of treating skin cancer in that it allows the Mohs surgeon to remove every cancer cell through the use of complete microscopic examination and detailed mapping of all of the tissues removed surgically.

Mohs surgery examines 100% of the margin of the excised tissues. This is accomplished by a special method of tissue orientation during processing. Excision using typical “frozen sections” prepared in a hospital, and standard surgical excision in the office which uses a paraffin embedded section examination, merely sample the edge of the excised tissues. These alternative forms of tissue examination provide only a tiny sampling of the tumor margin.

Only Mohs surgery utilizes a single physician in two capacities: (1) as the surgeon, and (2) as the pathologist. By knowing exactly how the tissue was removed, oriented, divided, and mapped, the Mohs surgeon can most accurately analyze the excised tissues.

Is there a board certification for Mohs surgeons?

Although there is no specific board certification for Mohs surgeons, there is a single organization which oversees post-graduate fellowship training and regulates the requirements for comprehensive training in this specialty. The organization is known as The American College of Mohs Micrographic Surgery and Cutaneous Oncology.

Although there are other societies with similar names, only The American College of Mohs Micrographic Surgery and Cutaneous Oncology requires extensive proctored fellowship training and proven competence under the supervision of a regulated director. It is very important that patients understand that the high cure rates often cited for Mohs surgery are results of studies performed by American College of Mohs Micrographic Surgery and Cutaneous Oncology members and may not represent results attainable by physicians who have not received American College of Mohs Micrographic Surgery and Cutaneous Oncology fellowship training.

Dr. Boyer is an associate member of The American College of Mohs Micrographic Surgery and Cutaneous Oncology.

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