Mohs Surgery for Skin Cancer

If you or someone you know has been affected by skin cancer, you may have heard of the term, Mohs Surgery. We teamed up with Dr. Bryce Cowan, a plastic surgeon and leading expert in Mohs surgery in Canada, to create a video series and an article to help educate the public about Mohs Surgery.

What is Mohs Surgery and why is it considered the gold standard treatment for skin cancer?

The major advantages of Mohs surgery, short for Mohs Micrographic Surgery, over traditional excision surgery is that it maximizes the cure rate for most skin cancers, and leaves the maximum amount of healthy tissue intact, which is important for cosmetic and functional reasons, especially in areas like the face.

In traditional surgery, skin cancer is removed surgically and an extra margin of tissue is taken to ensure that the cancer is removed. This is because only the surface of the skin cancer is visible. Then the tissue is examined in a lab to ensure that the entire cancer was removed. This means that re-surgery may need to be scheduled at a later date if the cancer was larger than expected, or often, too much tissue is taken needlessly to ensure safety. Mohs surgery improves on this by performing surgery and analyzing the skin simultaneously during the procedure. This ensures that the patient only undergoes one procedure (in most cases), and that the most healthy tissue is preserved. Mohs surgery provides the highest cure rate for skin cancers, and generally has the best cosmetic results as it minimizes the excision by not removing excess tissue--instead opting to take small pieces and analyzing it in real-time. It’s important to note, however, that Mohs surgery is not a catch all solution for all skin cancer cases, and will not replace traditional surgical excision in all cases.

When should I research more into Mohs Surgery?

Mohs surgery should be considered if a skin cancer has a high chance of recurrence or has already recurred after treatment. Each surgery and reconstruction has a chance of complicating and reducing the chances of success in the subsequent treatments as tissue in the surrounding area are broken up, making analysis more challenging. As Mohs surgery provides better visibility of the cancer in real-time it has the highest cure rate, maximizing the chances of successful treatment. Therefore, if your skin cancer is aggressive, has recurred or you’ve been told that there is a high chance of recurrence, you may wish to ask your surgeon about whether Mohs Surgery may be an appropriate option for you.

The other consideration is if the skin cancer is in an area where it’s important to preserve as much tissue as possible. If the skin cancer is near the eyes, or on the face, there are functional and cosmetic reasons that you want to minimize the amount of tissue that’s removed.

What are some reasons that Mohs Surgery may not be suitable?

Mohs surgery is typically not performed for treating melanoma. There is still debate on this subject, but many surgeons believe that traditional surgical excision may be better for treating this specific skin cancer. Dr. Bryce Cowan explains the reasons in more detail in this video. Secondly, for very early stage cancers where the surgeon can identify the extent of the skin cancer very easily, traditional surgery may be advised. Your surgeon will explain the specific reasons at consultation. Finally, Mohs surgery is still a relatively new and extremely technical procedure, and there are still very few surgeons who are qualified to perform this procedure. This may mean longer wait times, or depending on your location, you may have difficulty finding a qualified surgeon.

Mohs Surgery seems to be a relatively new procedure. I don’t really want to take chances with skin cancer. Is it really safe?

It’s true that Mohs surgery is a relatively new procedure compared to traditional excision, however, the results have been consistent in providing the highest cure rate for most skin cancers, and especially the most commons ones, Basal Cell Carcinoma and Squamous Cell Carcinoma. Safety is always relative--the cure rate is not 100%, but it is the best procedure we have for most skin cancers. You will need to talk to your surgeon about whether this is true for your specific case.

One real consideration and possible cause for concern is that there are still fewer qualified surgeon for this complicated procedure than is ideal. This may translate into availability limitations or longer wait times. As a patient, you will need to communicate your needs and priorities clearly with your doctor and discuss the pros and cons from the options that are available.

For one of the most comprehensive guides on Mohs Surgery, please watch this video series on our channel, skinexpertstalk.