Mohs Surgery for Skin Cancer

Mohs surgery is an excellent procedure for skin cancer on the face because it maximizes the cure and minimizes the scar. For a first-time basal cell or squamous cell carcinoma, it commonly achieves a 98 percent cure rate. For superficial basal cell or squamous cell carcinoma, using Aldera® has been shown to be effective and thus reduces any risk of scarring. 

Mohs surgery, named after Dr. Frederic Mohs who is its innovator,  is the most effective treatment for basal cell carcinoma and squamous cell carcinoma of the nose. Studies have shown that these neoplasms have a higher chance of recurring in this location as well as when they are located on the ears, temples, lips and a few other areas. Mohs surgery is indicated because of the location, but also for tissue conservation (produce the smallest hole possible), with the highest chance of cure by examining, not a representative margin, but 100% of the margin. Reconstruction is often done after the Mohs surgery to produce the best functional and aesthetic outcome.

Moh's surgery purportedly has the lowest rate of recurrence of all removal methods. Given the potential cosmetic and functional consequences of a recurrence, it has therefore become one of the preferred methods of treatment. Many other options are available but may not have the same "cure" rate.

I think one of the most telling ways to tell if a therapy is "the best" is to survey what "doctors do" when they need a treatment.  I will tell you that whenever physicians have a basal cell or squamous cell carcinoma on their nose, Mohs seems to be their first choice of treatment.  This hopefully adds some insight.  But more importantly are the long-standing, successful cure rates of Mohs Surgery.  As stated in prior responses, Mohs Surgery provides a 99% cure for basal cell cancers, and a 97% cure for squamous cell skin cancers. However, there are many alternatives to treating skin cancers on the nose that should also be considered; those treatments range from traditional excision, to topical chemotherapy creams, radiation, scraping and burning, lasers, photodynamic therapy, and newer immunologic oral drugs. Having a dermatologic professional at your side should help you tease apart what the pros and cons are to each option for treatment.  

Mohs Surgery is the best treatment for this skin cancer hands down.  As an board certified Dermatologist and American College of Mohs Surery fellowship trained, Mohs Skin Cancer Surgeon, I think that a fellowship trained Mohs Skin Cancer Surgeon is the most experienced and trained physician to perform Mohs Skin Cancer Sugery.

A Mohs Surgery fellowship is an additional 1-2 year training progarm after a Dermatologist completes his or her general Dermatology training and qualifies him or her as an expert in skin cancer recognition and treatment , including the Mohs skin cancer technique above and beyond that of any other medical professionals.

Mohs surgery is typically recommended for skin cancers on the nose, which are usually basal cell cancer or squamous cell cancer.  Mohs surgery has the highest cure rate.  That said, there are times when alternative treatments can be considered.  Imiquimod cream can be considered for certain lower risk skin cancers such as superficial basal cell cancer or squamous cell cancer in situ.  Other treatments which are sometimes performed are standard excision, electrodessication and curettage (scrape and burn) or radiation treatment. 

Mohs surgery provides the highest cure rate for skin cancer. With cure rates approaching 99% for previously untreated basal cell carcinoma and 95% for basal cell carcinomas that have been treated before but recurred, Mohs surgery provides a higher cure rate than any other form of treatment including standard excision, curettage and electrodesiccation (scraping and burning), radiation or topical therapies. At the same time by starting with as small of a surgical margin as possible and then tracing out the roots of the skin cancer, Mohs surgery preserves the greatest amount of healthy tissue. For this reason Mohs is particularly useful in areas where tissue preservation is of paramount importance, such as the eyelids, nose, lips, ears, hands and genitalia.

Mohs surgery is the gold standard for treating certain skin cancers of the nose including the most common types: basal cell carcinoma and squamous cell carcinoma.  It provides the highest cure rate with the least amount of tissue removed which results in the best possible cosmetic result.  The Mohs surgeon is able to concisely remove small sections of skin to visualize under a microscope in order to map out the entire tumor so there is no guess work.  The goal is to make sure all the skin cancer is removed but also to avoid removing any more tissue than is absolutely necessary in order to keep the defect size as small as possible. 

The high cure rate of Mohs can only be achieved by going to a qualified and trained Mohs surgeon.  There are many doctors who advertise doing Mohs who have not gone thru the rigors of a formal fellowship program.  The American College of Mohs Surgery (ACMS) is the only organization that requires its members to have successfully completed an extensive one- to two-year ACMS-approved fellowship training program after they have completed their years of residency training. 

Hi,

The biggest advantage of Mohs is the ability to meticulously and carefully map and remove a skin cancer on a critical area with a high cure rate and avoiding taking too much tissue.  The nose certainly falls into this category since this is an important cosmetic unit and avoiding anatomical distortion is very important since everyone looks at your nose.  The type of tumor is also important since some are more aggressive and tumor clearance with microscopic mapping is ideal.  A lot of information regarding the technique of Mohs Surgery is available from the American Academy of Dermatology, the American Society for Mohs Surgery.  If a patient for health reasons is unable to have Mohs, radiation with an experienced radiation oncologist is always an option.

Without a doubt Mohs micrographic surgery offers the best treatment for a skin cancer. Using a meticulous surgical and microscopic technique, a Mohs surgeon removes the cancer and spares healthy tissue around it. Given lower risk of recurrence and lack of incomplete excision, Mohs surgery is also the most cost effective treatment. As far as reconstruction of a cosmetically sensitive area is concerned, look for a Mohs surgeon with experience in such reconstructions. For example, a fellowship-trained Mohs surgeons spend an extra year perfecting Mohs technique and reconstructive surgery. Ask to see before and after photos if you still have any doubts. Or, if a defect is very challenging, i.e. involving bone, then a multi-specialty approach involving plastic surgeons, ENT, or oculoplastic surgeon may be necessary.