The Mohs Micrographic Surgery procedure relies on a specific sequence of surgery and pathological investigation:
The following schematic illustrates the fundamental steps of Mohs Micrographic Surgery:
Mohs Tissue Removal Procedure
The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur.
The visible portion of the tumor is surgically removed.
A layer of skin is then removed and divided into sections. The Mohs surgeon then color codes each of these sections with dyes and makes reference marks on the skin to show the source of these sections. A map of the surgical site is then drawn.
The undersurface and edges of each section are then microscopically examined for evidence of remaining cancer.
If cancer cells are found under the microscope, the surgeon marks their location onto the “map” and returns to the patient to remove another layer of skin - but only precisely where the cancer cells remain.
The removal process stops when there is no longer any evidence of cancer remaining in the surgical site. Because Mohs surgery removes only tissue containing cancer, it ensures that the healthy tissue is kept intact.
The best method for reconstructing the surgical wound is determined after the cancer has been completely removed and the extent of the surgical defect has been determined. The primary considerations are preservation of function and maximizing the aesthetic outcome. Small wounds may be allowed to heal on their own, or the wound may be closed with stitches. Facial wounds often require reconstruction with a skin flap, or sometimes a skin graft. Reconstructing a wound with a skin flap involves utilizing lax skin that is adjacent to the wound, whereas a skin graft is performed by removing skin from another area of the body. The benefits and risks of each option will be discussed with you at the time of your surgery. Dr. Bortz has had extensive training regarding wound reconstruction and has performed over 10,000 reconstructive procedures over the past 10 years. On occasion, if a tumor is much more involved than anticipated, the patient may be referred to another surgical specialist with unique skills to complete the reconstruction.