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Mohs Micrographic Surgery


What?

Mohs Micrographic Surgery (MMS) is a surgical technique invented by Dr. Frederic Mohs approximately 70 years ago. It involves surgical excision of cancer tissue and systematic examination with a microscope of all cut surfaces for 100% margin control. This surgical excision is correlated with a drawn map of the wound, which is why this technique is called "micrographic" surgery. Mohs micrographic surgery is a highly specialized procedure for the complete removal of skin cancers.

Who?

Typically, a Mohs surgeon is a board certified dermatologist that has passed an examination by the American Board of Dermatology (ABD) and has undertaken 1-2 years of additional training in an American Council of Graduate Medical Education (ACGME) approved Procedural Dermatology fellowship. After these credentials are completed, the Mohs surgeon is elected to become a fellow of the American College of Mohs Surgery (ACMS).

Where?

There are only a limited number of medical offices in the world equipped to offer Mohs micrographic surgery. It is time consuming and requires highly specialized training. The Mohs technique requires a dermatologist to function as a surgeon to remove tissue and as a pathologist to examine prepared slides with a microscope in a certified, on-site laboratory to map the tumor. Patients should check the credentials of their Mohs surgeon to make sure they are board certified dermatologists and Fellows of the American College of Mohs Surgery (ACMS).

Why?

Mohs surgery is currently the gold standard for the treatment of the most common skin cancers such as basal cell carcinoma and squamous cell carcinoma. These cancers arise from the top layer of skin cells.

Cancer is tissue that grows out of control. Both basal and squamous cell carcinoma can enlarge from the point where they initially occur and usually do not spread to other parts of the body. However, if not completely removed, both skin cancers can invade into tissue and destroy structures in their path. This may result in disfigurement of important structures such as the eyes, ears, and nose. Unlike internal malignancies, skin cancers are usually recognized by dermatologists and treated in their early stage, which typically results in a cure.

How?

Mohs micrographic surgery involves 5 separate steps:
  1. Bulk removal of the tumor with a skin scraping.

  2. Surgical removal of a thin layer of remaining tumor apparent to the "naked" eye.

  3. Drawing a "micrographic" map of the removed tissue and preparing glass slides of the skin with special stains to highlight and diagnose the tumor.

  4. Examination of the prepared slides with a microscope in the laboratory.

  5. If there is tumor present, further surgical excision at the positive cut surface or "margin" is required, and the prior steps (2-4) are repeated. However, if the examined area is free of tumor, then options for repairing the surgical site are discussed. This can include a simple sutured wound closure or more complicated flaps and grafts. And in certain circumstances the defects are left to heal on their own.
Why at the Center?

The center is the ideal place to do this procedure for several reasons.

This includes the 3 Mohs surgeons that we have: Drs. Robert J Roth, Jeffrey A. Carmel, and Erik S. Cabral, with a combined over 70 years of experience in this specialized technique. These physicians have completed specialized fellowships and advanced training with specialization in reconstruction. This is important because, in general, the site can be repaired after the tumor has been removed, on the same day, in our office. There is usually no need to have this done at another office or facility. Please contact us for further information.

The links below will also provide excellent information on this technique:

From the American Academy of Dermatology:

http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/skin-cancer/diagnosis-treatment

From the American College of Mohs Surgery:

http://www.skincancermohssurgery.org/

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Dermatologist Fremont - ABD Dermatologist Fremont - ASDS Dermatologist Fremont - ACMS Dermatologist Fremont - ASLMS Dermatologist Fremont - AAD