Today Mohs Surgery or Moh’s Micrographic Surgery is a well-established technique for removing skin cancers. The basic premise is that the skin cancer can be excised directly under local anesthesia. The tumor and surrounding tissue are oriented, mapped and then sectioned for evaluation under a microscope. In this manner, the tumor can be evaluated microscopically in real time. When tumor cells are identified at the border of the excised specimen, additional tissue can be removed in a very precise manner, since the location has been previously mapped. The advantage of this techinque is that it hopefully minimizes the size of the resulting defect, by keeping to a minimum the amount of “normal” surrounding skin (i.e. the margin) that is removed with the specimen.
In general, the indications to proceed with Moh’s Surgery (as opposed to traditional tumor excision) are the following:
1) Recurrent Skin Tumors
2) Tumors >0.6cm on the face (or >2.0 cm on the body)
3) Tumors in high-risk anatomic or cosmetically sensitive locations (eyelids, nose, ears, lips, fingers)
4)Tumors with indistinct clinical margins (or with a positive margin after a surgical resection)
5) Tumors arising in sites that had previous radiation or chronic scars (i.e. marjolin’s ulcers)
6) Aggressive Tumor types (micronodular, infiltrative, & morpheaform BCC, & invasive SCCA)
7) Tumors in immunosuppressed patients
*photos on this post are not actual patients of Dr. Brenner.