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Mohs surgery is a specialized surgical procedure primarily used for the treatment of certain types of skin cancer, particularly those with high risk of recurrence or those located in cosmetically or functionally sensitive areas.
The procedure involves removing thin layers of cancerous skin tissue one layer at a time and examining each layer under a microscope immediately after removal. This process continues until no cancer cells are detected in the examined tissue, ensuring that as much of the cancerous tissue as possible is removed while preserving healthy tissue.
This meticulous approach allows for the complete removal of cancerous cells while minimizing the removal of healthy tissue, thus maximizing cosmetic and functional outcomes.
Here are some common types as below:
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
Following are the procedure steps:
Local Anesthesia: The patient is given a local anesthetic to numb the area where the skin cancer is located. This ensures that the patient remains comfortable throughout the procedure.
Initial Tissue Removal: The surgeon removes the visible portion of the skin cancer along with a thin margin of surrounding healthy tissue. This initial tissue sample is then divided into sections and mapped for orientation.
Tissue Processing and Examination: The surgeon processes the removed tissue by freezing it and cutting it into thin layers (sections). Each section is then stained and examined under a microscope by the surgeon. The goal is to identify any cancer cells that may be present at the edges (periphery) or bottom (deep margin) of the tissue.
Mapping and Localization: If cancer cells are found at the edges or bottom of a tissue section, the surgeon uses the map created earlier to precisely identify the location of the residual tumor. This allows for targeted removal of additional tissue from the specific area(s) where cancer cells are present.
Repeat Steps: Steps 3 and 4 are repeated iteratively, with the surgeon removing additional tissue only from areas where cancer cells are still present, as indicated by microscopic examination. This process continues until no cancer cells are detected in the examined tissue margins.
Closure of the Wound: Once the surgeon confirms that all cancerous tissue has been removed, they discuss options for wound closure with the patient. Depending on the size and location of the wound, closure may involve techniques such as sutures (stitches), skin grafts, or other reconstructive methods.
Pathology Review: After the procedure, the removed tissue is further examined by a pathologist to confirm that all cancerous cells have been removed. This ensures the accuracy and completeness of the surgical excision.