Mohs surgery, named after the late University of Wisconsin Professor of Surgery, Frederick Mohs, is the gold standard for treatment of skin cancers. It is utilized mainly for basal cell carcinoma and squamous cell carcinoma, the two most common types of skin cancer. The technique provides cure rates of 99% while sparing surrounding healthy tissue, resulting in a smaller surgical defect and, ultimately, a smaller scar. By definition, Mohs surgery requires that the treating physician is both the surgeon and pathologist. The removal, processing and reading of the tissue is all under the direct supervision of one physician and the processing is done on-site. The method of removing tissue from the patient and the processing is different than the standard technique used by plastic surgeons and other non-Mohs surgeons in that 100% of the surgical margin is examined during Mohs surgery. The other methods, including standard bread loaf frozen sections and standard overnight processing, only visualize 2-3% of the actual margin and the remainder of the margin is interpolated or estimated. This is one reason why Mohs surgery has higher cure rates. Mohs surgery begins with the first “stage”, where a small piece of tissue is removed immediately around the edge of the visible cancer. The tissue is processed and examined microscopically. If the surgical margins are clear, the procedure is terminated and then the surgical defect can be repaired. If there is residual cancer at a margin, another “stage” is taken around this positive area and the tissue again examined. This process continues until there is no residual cancer at the margin. Mohs surgery remains the most effective technique at skin cancer extirpation while sparing the surrounding healthy tissue and providing the best cosmetic outcome. Dr. Leposavic has performed over 25,000 Mohs cases over the last 17 years.
