Mohs Surgery for Skin Cancer

Mohs Micrographic Surgery

We perform Mohs micrographic surgery in our office. Mohs surgery has the highest cure rate for treating basal cell carcinomas, squamous cell carcinomas, and most other skin cancer types. The procedure is performed in stages, including laboratory work while the patient waits. Sometimes removal of cancer and repair of the resultant defect, are performed on different days. For instance, if the repair is conducted by another physician, or if 'retention' sutures are used to stretch the skin overnight, which can significantly decrease the scar length.   

Mohs Surgery on Melanoma

Many people don't know that Frederick Mohs, who pioneered the surgery named after him, routinely performed and actually preferred the technique for melanoma.  Mohs surgery may be used to treat melanoma on areas requiring maximum tissue preservation, such as the face, scalp, ears, genitals, or digits.  The procedure can completely remove the melanoma while sparing as much normal skin around the tumor as possible.  Studies show survival and recurrence rates after Mohs surgery are equal or better to traditional surgery.  Dr. Hines is one of only several physicians in Washington State fellowship trained to perform Mohs surgery on melanoma.  We can use this technique to remove melanoma in-situ but also invasive melanoma depending on the clinical circumstances.  Mohs on melanoma is facilitated by use of rapid immunostaining using the MART-1 (melanoma-associated antigen recognized by T-cells), which highlights melanoma cells making them easy to see under the microscope (see photo below). 

Not every skin cancer patient is a candidate for Mohs surgery for melanoma, and your melanoma may require a more traditional surgery.  We can discuss the options with you and choose the approach that offers you the best outcome. 

For a video and more information, please click below:

Mohs Surgery Video

Mohs Surgery Info

Select references:

1.) Mohs FE.. Chemosurgery for Melanoma.  Archives Dermatol 1977:113:285-91

2.) Mohs FE. Microscopically controlled surgery for periorbital melanoma: fixed and fresh tissue techniques. J. Derm Surg Oncol 1985:11:284-91

3.) Mohs FE. Fixed tissue micrographic surgery for melanoma of the ear. Arch Otol Head Neck Surg 1988: 114:625-31

4.) Mohs FE et al, Mohs micrographic surgery for melanoma of the nose. J Dermatol Surg Oncol 1990:16:1111-20

5.) Snow, Mohs et al. Cutaneous malignant melanoma treated by Mohs surgery: review of treatment results of 179 cases from Mohs melanoma registry. Dermatol Surg 1997; 23:1055-60

6.) Valentin et al, Mohs Micrographic Surgery Using MART-1 Immunostain in the Treatment of Invasive Melanoma and Melanoma In Situ. Dermatologic Surgery, 2016, Jun;42(6) 733-44

 7.) Degesys et al, Outcomes for Invasive Melanomas Treated With Mohs Micrographic Surgery: A Retrospective Cohort Study. Dermatologic Surgery, 2019, Feb;45(2):223-228

 8.) Ellison et al., Mohs micrographic surgery for melanoma: A prospective multicenter study. Journal American Academy of Dermatology, 2019, 05:057

 9.) Shin et al., Mohs micrographic surgery with MART-1 immunostaining has durable low local recurrence rates for in situ and invasive melanomas. JAAD, 2021 Jan; 84(1):196-8