Mohs Surgery

Mohs micrographic surgery is the most modern, accurate, and highly specialized treatment for the total removal of skin cancer.

Mohs micrographic surgery has set a new standard in skin cancer treatment. An increasing number of physicians are performing Mohs surgery, which is now widely accepted as the most effective treatment for most types of skin cancer. However, not all Mohs surgeons receive the same level of training as Dr. Robert Griego and Dr. Daniel Skinner, both of whom are fellowship-trained Mohs surgeons.

When it comes to your skin cancer treatment, you deserve no less than the best. Both Dr. Griego and Dr. Skinner have achieved the highest degree of Mohs surgery qualification by completing an American College of Mohs Surgery (ACMS) approved fellowship. Both Dr. Griego and Dr. Skinner are board-certified dermatologists with expertise in facial reconstruction after skin cancer removal. For you, this means peace of mind, knowing that you will receive superior quality and competency, as well as an optimal outcome.

What is Mohs Surgery?

Mohs surgery (pronounced like "nose" with an "m") is named in honor of Frederick Mohs, M.D., the physician who developed the technique at the University of Wisconsin in 1936. Mohs method of skin cancer treatment is unique because it is the only method that provides the use of complete microscopic examination of all the tissues removed surgically, in addition to providing detailed graphic mapping techniques for orientation purposes; thus the term micrographic surgery.

This procedure allows the surgeon to visualize and remove every cancer cell. It is initiated after the skin has been numbed with a local anesthetic. The visible portion of the cancer and a very thin rim of surrounding skin are then removed and examined. Any remaining cancer seen during the microscopic examination is carefully marked on a map, which precisely locates the area relative to the patient's skin. Another thin layer of tissue is then removed from the exact area that demonstrated involvement with cancer. This sequence is repeated as often as necessary to completely remove the cancer.

Is there a board certification for Mohs surgeons?

Although there is no specific board certification for Mohs surgeons, there is a single organization which oversees post-graduate fellowship training and regulates the requirements for comprehensive training in this specialty. The organization is known as The American College of Mohs Surgery (formerly the American College of Mohs Micrographic Surgery and Cutaneous Oncology, ACMS).

Although there are other societies with similar names, only the ACMS requires extensive proctored fellowship training and proven competence under the supervision of a regulated director. It is very important that patients understand that the high cure rates often cited for Mohs surgery are results of studies performed by ACMS members and may not represent results attainable by physicians who have not received ACMS fellowship training. Dr. Griego and Dr. Skinner are Fellow members of the ACMS.

What is the difference between Mohs and Standard Surgery?

Mohs surgery examines 100% of the margin of the excised tissues. This is accomplished by a special method of tissue orientation during processing. Excision using typical "frozen sections" prepared in a hospital, and standard surgical excision in the office which uses paraffin embedded section examination merely sample the edge of the excised tissues. These alternative forms of tissue examination provide only a tiny sampling of the tumor margin.

Only Mohs surgery utilizes a single physician in two capacities: (1) as the surgeon, and (2) as the pathologist. By knowing exactly how the tissue was removed, oriented, divided, and mapped, the Mohs surgeon can most accurately analyze the excised tissues.

What are the advantages of Mohs surgery?

By using these detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. In addition, the complete examination of the tumor periphery removes the need for excision of a "margin for error," and allows for surgical margins 1/2 to 1/6 of that required for standard surgery. The results are:

• The highest possibility for curing the cancer
• The removal of as little normal skin as possible

What are my chances for cure using Mohs surgery?

As a result of the complete and detailed microscopic examination of all the skin surrounding the skin cancer, Mohs surgery performed by Dr. Griego or Dr. Skinner offers a chance for cure greater than 99% for most skin cancers, even when other forms of treatment have failed. Other methods of treatment may offer only a 50% chance of success when previous treatments have failed.