Mohs Surgery

Non melanoma skin cancer ---> treatment of Non melanoma skin cancer ---> Non melanoma skin cancer Surgery ---> Mohs Surgery

Mohs surgery was developed by Frederick E. Mohs, a general surgeon from the University of Wisconsin, in the 1940s. Initially, a chemical fixative paste was applied to the skin to fix the tissue in situ; hence, the now outdated term Mohs chemosurgery. The fresh tissue technique, which omitted the chemical paste, was developed and refined in the 1970s. Mohs micrographic surgery is most useful for the treatment of higher risk NMSC. Mohs surgery is usually performed under local anesthesia in an outpatient Mohs surgical unit. After removal of all gross tumor, the surgeon excises a thin layer of tissue with 2- to 3-mm margins. The tissue is mapped, color-coded for orientation, and sent to the technician for frozen-section processing. The specimen is flexible and flattened, with the beveled peripheral skin edge placed in the same horizontal plane with the deep margin. In this plane, both the deep and peripheral margins are examined in one horizontal cut by frozen-section analysis with total (theoretically 100%) margin control. Good-quality frozen sections may be achieved only by a skilled and experienced Mohs histotechnician. The Mohs surgeon functions as both surgeon and pathologist. After histologic interpretation of the frozen-section specimens, the precise anatomic location of any residual tumor can be identified and re-excised until all margins are tumor free. The Mohs surgeon's ability microscopically to track subclinical tumor extensions results in the highest cure rate with maximal preservation of normal tissue. Soft tissue reconstruction can then be performed on the same day, after completion of Mohs surgical excision of the tumor. A multidisciplinary approach involving Mohs, plastic, head and neck, and oculo-plastic surgeons and radiation oncologists may be needed for extensive tumors. Mastering the Mohs technique is based on a steep learning curve. The American College of Mohs Micrographic Surgery and Cutaneous Oncology requires 1 to 2 years of fellowship training with a minimum of 500 to 600 cases before certification.