Don Scott MD
Dermatopathology
When is Mohs appropriate?
Know the basics...
Mohs (microscopically oriented surgical sectioning) should NOT be the primary method to remove skin cancers in spite of what many patients have been told. Please contact Dr. Scott for a consultation and/or get a second opinion before you decide to have any Mohs procedure.
What is the Mohs procedure in dermatology?
Mohs micrographic surgery (MMS), or Mohs surgery, is a surgical technique used to treat various skin cancers that allows precise microscopic control of the margins by utilizing tangentially cut frozen-section histology.
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Over 90% of all skin cancers can be removed easily with MOHS surgery. But MOHS should only be used to remove difficult and/or recurrent skin cancers that fail conventional methods which the inventor (who happened to be named Mohs) intended.
The argument that adequate margins to eradicate the malignancy plus ensuring less recurrences is typically emphasized. However, an important concept about skin cancers, including melanomas, is that once you irritate or injure them with methods like freezing, cauterizing, curetting, slicing, or applying immune stimulating creams like imiquimod (all which can be can be called neoadjuvant therapy), the body’s innate defense mechanisms will destroy the tumor. This opportunity should not be missed or squandered.
These methods are not highly reimbursed like one gets in Mohs surgery which is the elephant in the room and we dermatologists all know it. Again this is a wonderful technique but it has unfortunately been somewhat abused. It’s often tragic that the treatment can sometimes be worse than the problem.