Traditional Surgery: Removing the entire skin cancer can be challenging. The skin cancer may have roots or extensions running under the skin that cannot be seen except under the microscope in stained tissue sections. Traditional surgery involves removing the skin cancer with an appropriate margin of normal tissue around the edges and sending it to a pathologist to examine the margins. This method of skin cancer removal is still the primary method used and has a cure rate between 70 and 90 percent. In many cases, however, Mohs surgery is a better option.
Mohs Micrographic Surgery was named after Dr. Frederick Mohs, a surgeon who pioneered this procedure. With Mohs micrographic surgery, the skin cancer is removed in the office using the Mohs technique under local anesthetic. A map of the tissue is created and oriented. Microscopic frozen sections are prepared and stained in the office laboratory. The surgeon examines them to determine if all the cancer cells have been removed. If there are remaining cancer cells, additional layers are taken in that area where the cancer cells are located. The Mohs surgery technique spares the amount of tissue that must be removed and nearly assures complete removal, since all the edges and the base of the tissue specimen are carefully studied microscopically.
Advantages and uses of Mohs surgery: This method has a 99 percent cure rate, but isn’t indicated for all skin cancers. Mohs micrographic surgery is used to completely remove recurrent skin cancers, larger skin cancers, and for skin cancers that might act more aggressively due to type or location. Mohn surgery allows for narrow margins and is therefore useful for removing skin cancer in areas without much tissue to spare (such as the nose and ear).
After Mohs surgery: After the skin cancer has been completely removed using the Mohs micrographic surgical technique, it may be allowed to heal naturally or reconstructive surgery may be performed. In some cases, Dr. McEwen will refer the reconstructive part of the surgery to a plastic surgeon.
Dr. McEwen is a member of the American Society of Mohs Surgery and has been performing the surgery since 2004. Achieving consistently excellent outcomes requires pre-operative planning by Dr. McEwen and his clinical and administrative staff.
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