The stages of Mohs surgery
1
The roots of a skin cancer can extend beyond the visible part of the tumour. If they are not removed, the cancer will return. The specialist examines the visible area and plans which tissue to remove.
2
The surgeon removes the visible portion of the tumour. The margins are examined and the areas where tumour remains are precisely identified.
3
The surgeon then removes another layer from the areas where tumour is still present, preserving as much healthy skin as possible.
4
If the surgeon finds cancer cells, their location is marked and another, deeper layer of skin is removed. This process is repeated until the tumour has been completely removed.
5
Tissue removal stops when there is no further evidence of tumour. Only tissue containing cancer is removed, ensuring that as much healthy skin as possible remains intact.
6
Once the tumour has been completely removed, the surgical area is reconstructed.
What is Mohs surgery?
Originally developed in the United States in the 1930s by Frederic Mohs, Mohs micrographic surgery (MMS) has been refined to become the most advanced, precise and effective treatment for several types of skin cancer. With Mohs surgery, dermatologists can precisely identify and remove an entire tumour while leaving the surrounding healthy tissue intact. Mohs surgery offers the greatest potential for cure, even when the skin cancer has previously been treated by another method; indeed, it is the treatment of choice in these cases.
This is particularly important because many skin cancers develop in sensitive areas such as the nose, lips or around the eyes. In these cases, the whole tumour needs to be removed while preserving as much healthy skin as possible.
Mohs surgery is highly specialised and should be performed by certified dermatologists who have undergone rigorous training in this technique. Dr Toledo is the only dermatologist accredited by the European Society for Mohs Surgery (ESMS) to perform this technique in Andalusia, Extremadura and the Region of Murcia.When is Mohs surgery appropriate?
Mohs surgery is mainly indicated for basal cell carcinoma, the most common malignant tumour, and squamous cell carcinoma. A variation of the technique, known as slow Mohs, is also used for recurrent squamous cell carcinomas, lentigo maligna and certain skin sarcomas (pleomorphic sarcomas and dermatofibrosarcoma protuberans).
Removal, tissue analysis, reconstruction and success rate:
Mohs surgery involves removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue is reached around the tumour (known as “clear margins”). Mohs surgeons are specially trained both in this technique and in reconstruction. Each tissue specimen is examined histologically by a pathologist immediately after the suspicious tissue has been removed. This gives the technique the highest success rate of all skin cancer treatments: up to 99%.
You can see how MMS is performed step by step here
What are the advantages of Mohs surgery over other techniques?
- Ensuring complete removal of the cancer during surgery, virtually eliminating the possibility of it growing back.
- Minimising the amount of healthy tissue removed
- Maximising the functional and cosmetic outcome of surgery
- Repairing the surgical area on the same day as cancer removal in the vast majority of cases
- Curing skin cancer when other methods have failed
What happens after surgery?
Because of the high success rate of MMS, most patients need only one procedure. In almost all cases, surgery also includes repair of the wound.
Removing the entire tumour in a single procedure has two important advantages. First, removing only what is necessary optimises the cosmetic result. Second, reducing the likelihood of recurrence to almost zero avoids the personal and financial costs of larger, more extensive procedures. It also means that regular follow-up is not needed more than once a year.
