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Mohs Skin Cancer Surgery

Skin cancer is the most common type of cancer found in both men and women in the United States. Mohs surgery is a specialized procedure for removing cancerous growths of the skin. The goal of Mohs surgery is to ensure that cancerous cells are removed completely and to reduce or eliminate the chance of future growths.

The multidisciplinary team at The University of Kansas Health System has extensive experience treating thousands of people with skin cancer. Mohs surgery is just one of the techniques used to provide comprehensive and compassionate care for our patients.

What is Mohs surgery?

Mohs surgery is a minimally invasive procedure used to treat skin cancer. It was originally developed by Frederic E. Mohs, MD, in 1936 and has a long history of success as a cancer treatment. Mohs surgery can be performed in an outpatient clinic with local anesthesia and has a high rate of success. The cure rate is approximately 99% for most skin cancers that have never been treated.

During the procedure the cancerous lesion or tumor itself is not only removed, but successive areas of the skin around the lesion are also removed. Each time a layer of skin around the site of the growth or lesion is removed, it is analyzed for the presence of cancer. Once a layer of the skin shows no signs of cancer, the removal process ends.

We offer a variety of appointment types. Learn more or call 913-588-1227 to schedule now.

Who can have Mohs surgery?

Mohs surgery may not be appropriate for every skin cancer, but is highly effective for many skin cancers including:

  • Basal cell carcinoma (BCC) refers to a tumor derived from basal cells, which make up the lower part of the epidermis. It is the most common type of skin cancer and is usually caused by a history of sunburns and long-term sun exposure. Most BCCs are slow-growing and rarely spread to other parts of the body. If left untreated, they can invade the skin and underlying tissue, including muscle and bone.

  • Cutaneous squamous cell carcinoma (SCC) refers to an abnormal growth of squamous cells, which form the upper part of the epidermis. It is the second most common type of skin cancer and is usually caused by long-term sun exposure. SCC often grows quickly and, if not treated, can invade underlying tissue and spread to lymph nodes and other parts of the body. Patients who are immunosuppressed (especially organ transplant recipients) are at increased risk for developing SCC.

  • Melanoma and melanoma in situ refer to tumors derived from melanocytes, or pigment-producing cells in the skin. Melanoma occurs on both sun-exposed and non-sun-exposed areas of the body, including the soles of the feet. Melanoma is more likely to spread throughout the body than other skin cancers, so early diagnosis and treatment are critical.

  • Such as atypical fibroxanthoma, dermatofibrosarcoma protuberans, sebaceous carcinoma and Merkel cell carcinoma.

    Mohs surgery is commonly used to treat skin cancers that occur in cosmetically or functionally sensitive areas such as around the eyes, nose, ears, scalp, fingers, toes or genitals. Mohs surgery also treats larger or more aggressive tumors on other areas of the body.

How does Mohs surgery work?

Mohs surgery works by completely removing all cancerous cells from the affected area of the skin. This is achieved through a gradual reduction of the affected area based on careful microscopic analysis of successive removals.

This technique allows for the complete removal of cancerous tissue while removing as little healthy tissue as possible. People who have Mohs surgery can typically expect better outcomes in terms of healing and scarring.

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Benefits and risks of Mohs surgery

Mohs surgery is considered a lower-risk procedure because it is a minimally invasive procedure that can often be performed in an outpatient setting. People who have Mohs surgery do not typically require an overnight stay at the hospital.

Mohs surgery carries a number of benefits for those who receive it. It is extremely effective at curing skin cancers such as BCC and SCC and it leaves the smallest scar possible, limiting the need for skin cancer reconstructive surgery.

What happens during Mohs surgery?

Mohs surgery occurs in one sitting with progressive stages. First, the treatment site is examined and prepared for the procedure. The site is cleaned and the anesthetic is injected to numb the area.

In the next step, the surgeon will remove the top layer of the tumor using a scalpel. This will allow further examination of the tumor to see how deep it has penetrated into the skin. The patient is bandaged and can relax while the tissue is analyzed.

The doctor uses this removed tissue to build a map of the tumor. The removed tissue is frozen and sliced into layers then examined under a microscope. Using dye, the doctor is able to map out areas where cancerous tissue is still present.

Another layer of skin is removed based on this map and analyzed further. This process repeats until the surgeon is confident all cancerous cells have been removed.

Afterward, the wound arising from the treatment can be closed with a bandage, stitches or even a skin graft, depending on its severity. In some cases, post-Mohs reconstructive surgery may be required to restore an unblemished appearance.

Mohs Skin Cancer Surgery

Jessica Lovell: In our morning rounds today, First Lady Dr. Jill Biden underwent surgery this week after doctors found a small lesion. Above her right eye it was found during a routine skin cancer exam. The procedure is known as Mohs surgery and we want to bring in Dr. Jessalyn. Tate, Director of dermatologic surgery and Mohs micrographic surgery. Dr. Tate Good morning to you exactly what is Mohs surgery and is it pretty routine?

Dr. Jesalyn Tate: Good morning. Yes. So Mohs surgery is a specialized skin cancer removal technique. Not every cancer is going to qualify for Mohs surgery or needs Mohs surgery. But whenever we do it, it's really for those cancers in the cosmetically sensitive areas or the areas where we don't have a lot of extra skin. And so with it, what we do is we numb people up just like they did for their biopsy at the time of diagnosis. And then we remove that skin cancer, and we take a very narrow margin with most surgeries, so we're able to save that normal healthy skin. And then we process that in our lab, we freeze that we stain it and I look at it underneath the microscope, and we make sure all those skin cancer cells are gone. And we keep going with that process until the patient is cancer free and there is no more cancer cells remaining. As soon as we're done there, then we get the patient back together. And so Dr. Jibbe is our other Mohs surgeon. And of course myself were trained in cosmetic reconstruction as well after Mohs surgery, so making sure patients get a good long term outcome.

Jessica Lovell: So Dr. Tate during the First Lady's pre op screening, there was a second area on her chest that looked kind of concerning doctors removed it and found it was basal cell carcinoma. So does that mean that Dr., Jill Biden has skin cancer? Is it because that sounds serious? Are there further concerns?

Dr. Jesalyn Tate: Yeah, great question. So yes, basal cell carcinoma is a subtype of skin cancer or type of skin cancer, I should say. It's actually the most common type of skin cancer we see it very, very commonly. It's one of the, definitely the most common that I treat. And you know, the good thing about basal cell it's a low risk skin cancer as far as things go, it's not kind of scary when we hear about the spreading and metastasis and all those scary things we hear about with melanoma, basal cell's generally low risk, however, it can be locally invasive. So we want to make sure we get that skin cancer out with clear margins, just to make sure it doesn't cause the patient long term problems.

Jessica Lovell: You and I were talking before the the program that I told you that I had Mohs surgery because I had basal cell right smack dab in the middle of my chest, very noticeable. That was about 10 years ago, when I had Mohs, I'd never heard of it, actually. But I thought, hey, if that's what we got to do to get rid of it, let's do it. So has it advanced at all in that last decade? Or is it just more common and people are more aware of it?

Dr. Jesalyn Tate: Yeah, a little bit of both. So definitely, it's more well known, I think as a skin cancer treatment. There's more fellowship trained Mohs surgeons now in the country, then there were 10 years ago. So I think the importance of fellowship training with Mohs surgery has been really well recognized and, and knowing that your doctor has really been trained to do your skin cancer removal, and to do your reconstruction. And so I would say in ways the core process of Mohs surgery hasn't changed in the last 10 years. I don't think it's changed in the last 30 years. But I will say we're treating more cancers than ever before with Mohs, we're using immuno stains now to treat melanoma and other rare cancers. So I think it's becoming more widely available, more well known, more recognized. But also I think we're advancing our techniques with treating more rare or more challenging skin cancers.

Jessica Lovell: Skin cancer screenings, it's year round for you, and certainly for all of us. But as we start getting ready to think about spring and getting out in the sun more often and planning those trips out in the sunshine, just give us some warnings, what we need to think about and certainly just a good reminder about getting screened and getting our skin checked.

Dr. Jesalyn Tate: Yeah, so I think you know, if you're in your 20s, 30s, and you haven't had a baseline skin check, I highly recommend it. I think it never hurts to get your skin checked. When you're younger. And especially if you're older than that, definitely set yourself up for a good check over. You know, with a board certified dermatologist, you're getting the best care, you're getting really a good close look at all of your skin lesions, making sure there's nothing to worry about. And then for each patient, it's different. We say hey, we don't need to see you back for a few years for another check. Or sometimes we want to see them back really frequently depending on how high risk they are for skin cancer and we kind of make that determination based on the patient's age, sun exposure, and what we see whatever we look at their skin.

Jessica Lovell: Okay, I'm maybe a couple of months past my year exam. I'm very good about getting it so I'm gonna make a note and I will make my appointment I promise Dr. Tate when I get off the air. Okay, I'll come see your team. Thank you so much for being with us this morning. Good to see you.

Why choose us for Mohs surgery

Mohs surgery is a highly sought-after, specialized dermatologic surgery to remove malignant tissue and avoid extensive surgery, wide incisions or skin flaps. The procedure is very technically challenging and requires a high level of skill.

At The University of Kansas Health System, we offer the experience of fellowship-trained, board-certified physicians as part of your care team. In addition, our leading Mohs surgery specialist has completed more than 1,000 successful Mohs procedures.

In certain cases, our health system provides immediate reconstructive surgery in tandem with Mohs surgery to ensure the best cosmetic result. Our streamlined referral process ensures that you have access to the reconstructive surgery experts you need as quickly as possible.

Our dermatology program is nationally recognized and offers innovative tests and treatments, a comprehensive care model, transplant dermatology and psoriasis treatment, so you can trust you're receiving the best care available.