Mohs Surgery

Mohs micrographic surgery, commonly referred to as Mohs surgery, is a highly specialized surgical technique for removing skin cancer with incredible precision. The procedure was developed by Dr. Frederic Mohs in the mid-1930s and perfected over many years.

Unlike standard excisions, where the cancer and a wider margin of surrounding skin are removed all at once, Mohs surgery removes the cancer layer by layer. After each layer is removed, it is examined under a microscope for cancer cells. If cancer cells are still present at the edges, another layer is removed from the exact area where the cancer remains. This process continues until no more cancer cells are detected.

Because of this step-by-step approach, Mohs surgery allows for the complete removal of skin cancer while sparing as much healthy skin as possible. This makes it especially valuable when treating cancers in cosmetically and functionally sensitive areas.

Mohs surgeon Dr. Joshua Freedman performs Mohs surgery both as the surgeon and as the pathologist, evaluating tissue samples at each stage of cancer removal. This procedure requires highly specialized training and expertise.

Mohs surgery is not necessary for every case of skin cancer. However, it is recommended in several situations where precision and tissue preservation are critical.

It is often used to treat:

• Basal cell carcinoma (the most common form of skin cancer)
• Squamous cell carcinoma (the second most common type)
• Specific forms of melanoma in situ (early melanoma limited to the top layer of skin)

Dr. Freedman typically recommends Mohs surgery in cases where:

• The cancer is located in high-risk or delicate areas such as the face, nose, ears, lips, scalp, hands, or feet.
• The cancer is large, aggressive, or has irregular borders.
• The cancer has returned after prior treatment.
• Preserving as much healthy skin as possible is essential for appearance and function.

Mohs surgery is performed in a specialized surgical suite within Dr. Freedman’s office, designed to optimize the patient experience. The removed tissue is processed and examined under a microscope in the on-site laboratory during the procedure.

Patients remain awake during the procedure, which is performed under local anesthesia. This means there is no need for general anesthesia, reducing risks and recovery time. Depending on the size and complexity of the cancer, the surgery may last several hours since each layer must be examined before moving on to the next.

The benefits of Mohs surgery make it one of the most trusted options for skin cancer removal:

Highest cure rates: Mohs surgery has the highest cure rates of any skin cancer treatment, with success rates up to 99% for certain cancers. By checking every layer under the microscope, surgeons can have the highest level of confidence that all cancer cells have been removed.

Preservation of healthy tissue: Because only cancerous tissue is removed, Mohs surgery preserves as much healthy skin as possible. This is especially important for cancers on the face, scalp, or other visible or functional areas such as the hands and feet.

Immediate results: In almost every single case, patients leave the office knowing that all the cancer has been removed that same day. There is no need to wait for lab results from another laboratory, as Dr. Freedman evaluated the tissue on site in the Mohs laboratory he created.

Lowest risk of recurrence: By ensuring all cancer cells are removed, Mohs surgery significantly reduces the risk of cancer recurrence. While nothing in biology or medicine is ever 100%, Mohs surgical results consistently provide the closest possible approximation.

Once the cancer is completely removed, the focus shifts to repairing the wound. Reconstruction is a vital part of Mohs surgery, particularly when performed in highly visible areas such as the face.

The reconstruction method depends on the size and location of the wound:

• Direct closure: Small wounds can often be closed with simple stitches.
• Skin flaps: In some cases, healthy skin from nearby areas is carefully repositioned to cover the wound.
• Skin grafts: When necessary, skin may be taken from another part of the body to repair the surgical site.

Because Mohs surgery minimizes the size of the wound by removing the least amount of tissue, reconstruction is usually less extensive than with traditional excision. Mohs surgeons trained in reconstructive techniques, such as Dr. Joshua Freedman, can skillfully restore both function and appearance, often with minimal scarring.