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Published on October 31, 2018

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Understanding Mohs Surgery and Skin Cancer

More people face skin cancer than any other type of cancer, and a technique that dermatological surgeons apply can make sure the cure-rate is as high as possible.

It’s called Mohs (moes) surgery, and while it’s not perfect for every malignant lesion, it is an effective method that keeps incisions small, all while giving patients a high chance of complete recovery.

“It’s an effective technique to address skin cancer, especially lesions on the face. We can make the margins as small as possible, but at the same time have great effect on treating – and healing – the cancer,” said Jenny Nelson, MD, Avera Medical Group dermatological surgeon.

What It Is

Most often, Mohs surgery can take place at the doctor’s clinic. The patient is awake with an anesthetic applied to the area that will be treated.

The surgeon cuts away the visible skin cancer and a thin layer of surrounding skin. The wound is then covered and the patient waits while the surgeon views the skin under a microscope. If cancer cells are found, another layer of skin is removed. If not, the wound can be closed. The technique allows the surgeon to remove as little surrounding skin as possible for a smaller, less visible scar.

Where It Is Used

Nelson said Mohs surgery, in addition to the face, is most commonly used on the hands, feet and genitals. Margins are usually 1-2 millimeters in size, which is much smaller than a more traditional approach to removing skin cancer lesions.

“Another advantage to this approach is we can take the tissue and treat it in real time,” she said. “The patient can begin the process and remain in our office while we examine the excised tissue. There’s a huge advantage to that in terms of patient convenience.”

The mass is evaluated in stages.

“If we find that it’s positive – the patient is already numbed and we can do second or third stages as needed,” said Nelson. “We also can complete the reconstruction, and in a few hours the patient is done, without having to return for additional treatment.”

Not Used In All Skin Cancer Cases

There are simpler approaches that also can address skin cancer lesions. Mohs surgery is an effective choice, but it’s not the only one available.

“It’s a best choice for cosmetically important places like the face, or when functionality is critical, like the hands or fingers,” Nelson said. “While Mohs surgery in not ideal for every skin cancer, it is effective for many, especially in the areas of the body we mentioned. Lesion size is another consideration; so too is the growth pattern of the cancer.”

Some lesions will grow uneven “tentacles” deeper in some spots than in others. These infiltrative patterns are considered before the type of skin-cancer removing surgery is decided.

“Tumors vary in size, shape and depth. They are not always an easily approachable ‘ball’ of cells on the surface,” Nelson said. “When you meet with us, we can guide you and review your case to find the best possible approach. It may be Mohs surgery – it is an effective tool in our cancer treatment. But we’ll always work with patients to find the best approach for their individual case.”

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Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

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