Updated May 19, 2020
The number of people developing skin cancer has been increasing for decades, to the point that skin cancer is now the most common cancer in the United States. Every day, more than 95,000 people are diagnosed with the disease, and one in five people will develop it in their lifetime.
Most cases are slow-growing nonmelanoma skin cancers like basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
Sun exposure and indoor tanning are the biggest risk factors for developing these skin cancers, and most of them form in areas that get the most sun, such as the head and neck. For people who develop BCC, SCC or some early melanomas, Mohs (pronounced “moes”) surgery is a very effective treatment, with a cure rate of up to 99 percent according to the Skin Cancer Foundation. The technique also provides the best cosmetic results of any skin cancer treatment.
What is Mohs surgery?
Mohs surgery, also known as Mohs micrographic surgery, is a technique invented by Dr. Frederic Mohs in the 1930s. Since being refined in the 1970s, it’s become a mainstream treatment for skin cancers on the head and neck.
Mohs surgery differs from more routine skin cancer removal surgery in that it’s done in stages. After the surgeon removes a layer of tissue, he or she examines it under a microscope to see whether it contains cancer cells. The process is repeated until no more cancer cells are found. This way, healthy tissue is spared, and the scar is minimized.
In Mohs surgery, all of the edges (called “margins”) of the removed tissue are evaluated, which is not the case with conventional surgery according to Dr. Justin Platzer, a board-certified dermatologist at Water’s Edge Dermatology. In conventional surgery, “[the sample] is cut differently, and it’s only a small fraction of the margin that’s evaluated, so you can miss tumors.” By contrast, he said, “Mohs surgery allows for recurrence rates of tumors to be as low as 1 percent.”
How does Mohs surgery work?
After injecting a local anesthetic to numb the skin, the surgeon removes the visible portion of the cancer along with a thin segment of surrounding skin and examines it under a microscope. Water’s Edge Dermatology has an onsite pathology lab where samples are read immediately, and patients learn the results throughout the procedure. (Patients who undergo traditional skin cancer surgery can wait up to a week to get pathology results indicating whether or not the cancer is gone.)
If the sample contains cancer cells, the surgeon removes an additional layer of skin and sends it back to the lab. “If it’s positive [for skin cancer] in just one area, you’re able to take a little more of the skin only in that area, so it keeps the wound smaller,” explained Dr. Platzer. This process is repeated until the margins are clean, meaning that no cancer cells remain. Most patients need only two rounds to remove all the cancerous tissue. The procedure lasts a few hours.
After the cancer is removed, the surgeon will decide whether and how to repair the wound. Smaller wounds are often left to heal on their own. Larger wounds may require stitches or even skin grafts. At Water’s Edge Dermatology, surgical removal, lab evaluation and wound reconstruction are done in one visit in most cases. When patients walk out of the surgery, they have peace of mind knowing that their cancer is fully treated.
Who should have Mohs surgery?
Mohs surgery is typically recommended for nonmelanoma skin cancers in places where you want to preserve as much healthy tissue as possible to maintain maximum function and provide a good cosmetic result, such as around the eyes, ears, nose, mouth, hands, feet and genitals. Mohs is also used to treat cancers that:
- Returned after initial treatment
- Have a high risk of recurring
- Weren’t completely removed by other treatments
- Are large or aggressive
Will Mohs surgery leave a scar?
All surgical procedures have the potential to leave a scar. Mohs surgery often results in smaller, less noticeable scars than other skin cancer removal methods. Most scars improve in appearance naturally over time. “It takes a full year for scars to fully heal, but most scars from Mohs surgery start looking cosmetically acceptable after four to six weeks,” said Dr. Platzer.
Is Mohs surgery covered by insurance?
Most insurance plans, including Medicare, cover Mohs surgery. Check with your insurance provider to confirm that Mohs is covered under your plan.
What should I do if I am concerned about possible skin cancer?
If you have a suspicious area on your skin, make an appointment to have it evaluated as soon as possible. If the dermatologist suspects skin cancer, he or she may perform a biopsy for further examination.
Don’t think you’re too young for skin cancer. Nonmelanoma skin cancers typically appear after age 50, but even people in their 20s and 30s can develop them, according to Dr. Platzer. “It takes a while to develop a BCC or SCC, so people usually have to be pretty fair-skinned and have significant amounts of sun damage to have it when they’re very young, but it’s definitely possible to get it then.”
To book an appointment for a skin evaluation, call (877-544-3880) or request one online. It’s a good idea to have your skin examined at least one a year. The sooner skin cancer is detected and treated, the better the chances of a complete cure, and the lower the chances of disfigurement.