Skin cancer treatment: Mohs Surgery

Skin cancers are on the rise in the United States. To get answers on a microsurgical treatment called “Mohs surgery,” we spoke to Timothy Wang, MD, director of the Mohs Surgery Program at Johns Hopkins Hospital.

In Mohs surgery, a dermatologist performs the dual role of skin cancer surgeon and pathologist. The Mohs procedure involves the surgical removal of the visible portion of the skin cancer, along with a layer of the surrounding skin. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery.

Mohs surgery has primarily been used for treatment of basal cell and squamous cell carcinomas. What are the indications/criteria for use in patients diagnosed with melanoma?

Timothy Wang, MD, performs surgery at Johns Hopkins Hospital (Johns Hopkins Photo)

Mohs surgery is typically used to treat basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), and its use in the treatment of melanoma is multifaceted. In 2012, the American Academy of Dermatology, American College of Mohs Surgery, American Society of Dermatologic Surgery and American Society for Mohs Surgery released “Appropriate Use Criteria for Mohs.”

This paper specifically stated that due to the complexity of the issue, invasive melanoma was not included in the article. Generally, their published indications for Mohs for melanoma include untreated (primary) and previously treated (recurrent) melanoma-in-situ (MIS) on the head and neck.

What is the cure rate and risks of Mohs surgery?

The cure rate for any type of therapy varies based on many factors. Cure rates of higher than 95% have been reported for many BCCs and SCCs treated by Mohs.

Mohs is typically performed as an outpatient procedure using local anesthesia only. It is generally considered a safe and effective treatment. As with any surgical procedure, risks and complications include pain, bleeding, infection, poor healing, recurrence and others.

How long is the healing process?

After Mohs has been used to remove the skin cancer, the resulting defect is often repaired using sutures. The time it takes to heal is affected by factors such as the size and location of the defect and the type of repair used. Recovery time typically ranges from one to a few weeks. The surgeon performing Mohs often repairs the Mohs defect or sometimes works in conjunction with colleagues in reconstructive surgery.

Mohs can be performed on multiple lesions on the same day but much depends on the size and location of the lesions, the predicted repairs, as well as patient factors such as medications and underlying health.

How many Mohs procedures should a dermatologist have done to be considered an expert?

Training programs for Mohs surgery vary. The Accreditation Council for Graduate Medical Education (ACGME) currently offers accreditation to fellowship programs in Procedural Dermatology (soon to be re-named Micrographic Surgery and Dermatologic Oncology), and a major part of this training includes education in both Mohs and complex surgical repairs. These programs must provide at least 1,000 surgical procedures of which at least 600 must be Mohs cases.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

Healthnetwork Foundation is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: [email protected]