About Mohs Surgery - What is Mohs?

Mohs micrographic surgery is a highly specialized outpatient procedure which allows a physician to remove skin cancers. The technique, created by Dr. Frederick Mohs, originally used a fixative paste to fix the tissue. This was later modified with the advent of frozen section processing and is technically known as modified Mohs technique. This technique requires a lab capable of performing frozen sections and histologic slide preparation.

The basic steps are as follows:

• The skin cancer is identified then localized via physical examination
• A local anesthetic (usually lidocaine) is injected around the skin cancer.
• The tumor is then debulked utilizing a curette. This allows the surgeon to appreciate any extension of the tumor that wasn’t obvious before.
• The physician then removes a thin layer of tissue that encompasses the periphery and the deep aspect of the apparent edges of the skin cancer.
• The tissue is then sectioned into smaller pieces to make slide preparation easier. These smaller pieces are then dyed, which helps the surgeon keep the specimens oriented once they are transferred to slides. This helps to distinguish between top and bottom and left from right. A drawing is made so that the physician can pinpoint any areas of tumor that crosses the excised border. This drawing is called the Mohs map.
• These pieces are then frozen and thin slices are taken from the underside of the pieces and placed onto slides.
• The slides are placed into a tissue stainer, which makes microscopic examination of the tissue possible. This stains the tissue and allows for the differentiation of normal cells and cancerous cells.
• The slides are then examined by the Mohs surgeon with a microscope.
• After examining the edges and underside of the removed tissue, the Mohs surgeon outlines the exact location of any areas of cancer. If more cancer is found, the procedure is repeated in stages until the physician finds that no cancer cells remain.

The following graphical representation is offered to help further explain the process.


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