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First Lady Dr. Jill Biden recently had Mohs surgery to remove a skin lesion above her right eye. Mohs surgery is performed about 850,000 times a year in the U.S. The precise care surgeons can deliver with this procedure is part of the reason more patients like Dr. Biden are experiencing skin cancers as disruptions, not debilitating conditions.
Mohs surgery, named for its inventor, Dr. Frederic E. Mohs, is a precise procedure to treat nonmelanoma skin cancer while removing as little skin as possible. Performed under a microscope, it is often used to remove lesions in sensitive skin areas, such as the face, neck, genitals, fingers, and spots where skin is over bone, like the shin.
Skin cancer is the most common and treatable form of cancer in the U.S. Each year, about 4.3 million adults in the nation are treated for the most common types of nonmelanoma skin cancer, basal cell and squamous cell carcinoma. When it’s detected early, the five-year survival rate for these cancers is about 99%. About 4,000 U.S. patients die each year from these cancers due to a suppressed immune system or delayed treatment.
The Mohs surgery procedure offers personalized results, and advances in surgical technology are making this intricate procedure available to treat more types of skin cancer than ever before.
How is Mohs surgery performed?
Mohs surgery is recommended for patients with skin cancers on cosmetically and functionally important sites such as the face, cancers that have come back after other treatments, those that are particularly aggressive or large, and cancers with edges that are difficult to see with the naked eye.
Because the cancer has already been identified in patients, during Mohs surgery we can focus on ensuring the removal of all the cancer from the edges of the lesion while sparing surrounding unaffected skin. Prioritizing these edges means we can get more complete results than in traditional skin cancer surgery, which can sometimes miss cancerous tissues around the edges of the spot.
The specially trained Mohs surgeon removes and freezes thin layers of skin, carefully examining the edges of each slice under a microscope to check for any remaining cancerous tissue. The surgeon removes and analyzes one layer of skin at a time, until there is no sign of cancer under the microscope. In the process we remove as little normal tissue as we can, which often means a smaller scar. Mohs surgery is an outpatient procedure performed with only local anesthesia. Most patients drive themselves home after surgery.
Related reading: Top 7 Things That Increase Your Risk of Melanoma and other Skin Cancers.
The surgeon is trained in frozen section pathology, in which we freeze the skin tissue instead of using a fixing solution, which can take 24 hours or longer to be ready for the microscope. This technique means we can look at the tissue we’ve just removed to check for cancer. This real-time analysis allows us to take immediate action if there is remaining cancer, instead of waiting several days for lab results.
The latest process, called Slow Mohs, is a variation of the original technique. Instead of real-time pathology, samples are sent to the laboratory for analysis of special populations of cells. This enables the production of additional slides that can be examined under the microscope, allowing doctors to pinpoint additional cancer cells that are harder to see than with traditional techniques.
Slow Mohs incorporates the best of traditional treatment with Mohs techniques. This allows surgeons to be especially precise and complete when removing more complicated cancers.
Advantages of Mohs surgery.
Many patients choose Mohs surgery because there are a number of short- and long-term benefits. These include:
Less pain: Many patients only take acetaminophen for pain, or nothing at all.
Local anesthetic: We don’t put patients under general anesthesia for Mohs surgery. Instead, we numb the surgical area only. This makes Mohs surgery a safer option for more patients, including those on blood thinners, and patients with medical conditions who cannot safely have general anesthesia. Many patients can drive themselves home after the procedure.
Clinical success: In most cases, our patients are cancer-free following Mohs surgery, and complications are rare. The precision of the Mohs procedure allows us to minimize scarring and save healthy tissue.
Smaller scar: Because of the precise manner in which we focus on removing the cancer while sparing normal skin, Mohs surgery can result in a smaller scar compared with traditional surgery.
Cure rate: Mohs surgery results in excellent five-year cure rates: 99% for basal cell carcinoma and 92-99% for squamous cell carcinoma. Even recurrent nonmelanoma skin cancers have five-year cure rates above 90% after Mohs surgery.
For many patients, including Dr. Biden, Mohs surgery can lead to excellent outcomes with minimal disruption to daily life. This technique allows surgeons to deliver precise cancer care, tailored to each patient, and it allows us to achieve the best possible outcome: freedom from skin cancer.
