Mohs Surgery: Careful Steps for Treating Skin Cancer
We spoke with Matthew Zipoli, MD, a dermatologist who specializes in Mohs skin cancer surgery, as well as general dermatology and cosmetic dermatology. Dr. Zipoli recently joined the medical staff at Emerson Hospital and practices at Dermatology Associates of Concord.
What is Mohs surgery?
Mohs surgery is a specialized skin cancer surgery developed by Dr. Frederic Mohs at the University of Wisconsin. The goals are to remove the smallest amount of tissue and to cause the least amount of scarring. With this type of surgery, we see exactly where the cancer is, map it and, as a result, remove the least amount of healthy tissue.
How is Mohs surgery performed?
Instead of removing the cancer in one step and sending a tissue sample to a pathologist, we take the smallest amount of tissue along with a 1- or 2-millimeter margin just around and underneath the cancer. Then we create a frozen section, stain it and analyze it under a microscope right here in the office. With the patient waiting, we determine if there is any cancer tissue remaining, such as roots that penetrate more deeply into the skin. If there is, we repeat the process by removing additional tissue with microscopic guidance until we are sure all the cancer is gone.
Is it appropriate for all skin cancer surgery?
Mohs surgery is used for treatment of non-melanoma skin cancers, which include basal cell carcinoma and squamous carcinoma and comprise more than half of the skin cancer diagnosed each year. Mohs is the best approach in cases where skin cancer is located on the head or neck. Those areas have the least amount of skin, which is needed to close the area where the cancer is removed. Consequently, Mohs surgery is often performed on the nose, eyelid, neck, lip and ear. We also perform Mohs surgery when a patient has an aggressive skin cancer or has had recurrence of non-melanoma skin cancer.
Does Mohs surgery take longer than traditional skin cancer surgery?
Yes. It requires several hours because we typically need to take two or three frozen sections. We inform patients that the surgery may take all day because it’s a process of pursuing the skin cancer one step at a time. As I tell my patients, we want to do it once and do it right. They understand that the extra time required for Mohs is well worth it.
How effective is Mohs surgery?
It is very effective. With Mohs surgery, we achieve cure rates of 98-99 percent. And because we cause a smaller defect in the skin, the amount of scarring is less than occurs with traditional surgery. Patients who have Mohs surgery are typically very happy with the cosmetic result, in addition to having peace of mind that all the cancer was removed.
Do all dermatologists perform Mohs surgery?
Many do though Mohs surgery requires specialized training. Governing bodies like the American College of Mohs Micrographic Surgery certify dermatologists and provide comprehensive fellowship training.
For more information on dermatologists at Emerson Hospital, visit our Find a Doctor section or call the Physician Referral Line at 978-287-3456.
