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Five things to know about Mohs surgery for skin cancer

Mohs surgery is a quick and highly effective procedure designed to treat skin cancer. We asked Dermatologist Amanda Tschetter, MD, a Mohs surgery specialist, to tell us more about this procedure.
It’s fast, accurate and highly effective. University of Minnesota Health Dermatologic Surgeon Amanda Tschetter, MD, explains how Mohs surgery has changed the way we treat skin cancer.

Amanda Tschetter, MD, just wants to make things quick and easy for skin cancer patients.

Tschetter is a dermatologic surgeon with University of Minnesota Health and an assistant professor in the University of Minnesota Medical School’s Department of Dermatology. She is also an expert in Mohs surgery, a surgical technique that treats skin cancer by gradually removing thin layers of skin from a skin cancer site until a patient is cancer free. Unlike other skin cancer surgeries, Mohs surgery can be completed in just a day, is essentially painless and is highly effective. It can be used to treat basal cell carcinoma and squamous cell carcinoma, in addition to melanoma.

A South Dakota native, Tschetter also treats other complex skin tumors, performs reconstructive operations after skin cancer surgery and can remove superficial, low-risk skin cancers using a specialized laser.

We caught up with Tschetter to talk about five things we should know about Mohs surgery.

Mohs surgery is very precise.

During Mohs surgery, a dermatologic surgeon like Tschetter removes skin from a skin cancer site one stage at a time. First, a dermatologic surgeon outlines the lesion with ink to map the tumor. After a local anesthetic is applied, the doctor removes the thinnest possible layer of cancerous tissue. While the patient waits, that layer is submitted to an onsite pathology lab for processing so the dermatologic surgeon can then read the tissue under the microscope to determine whether any cancer remains. If skin cancer persists, the dermatologic surgeon calls the patient back into the operating room and takes another layer—and the process is repeated until all cancerous tissue has been removed.

In other skin cancer procedures, a pathologist may only study a small fraction of a much larger sample to determine whether any cancer remains, and the results often take days to process. Surgeons like Tschetter have been trained to act as both the surgeon and the pathologist. They remove the tissue, then conduct a comprehensive study of the entire sample to ensure a patient is cancer-free before moving on to reconstructive surgery.

“Because of the way we process these tissue samples, looking at 100 percent of the margin, we can know for certain when we’ve removed all of the cancer,” Tschetter said.

Learn more about University of Minnesota Health dermatology care.

Mohs surgery leaves less scarring.

Because of its incremental and precise approach, Mohs surgery requires a smaller incision, which results in less scarring. The process removes a minimal amount of normal skin surrounding the cancer—only taking what is needed to remove the cancer.

“Because we check the entire surgical margin, we are able to spare more normal skin so the resulting wound is smaller. This smaller wound results in a smaller surgical repair process which can be more cosmetically appealing,” Tschetter said. Tschetter is equally precise when repairing a surgical site as she is when first removing and testing the tissue, which is ideal for skin cancer sites on a patient’s head, neck or face.

Read more about Mohs surgery. 

The procedure is quick and efficient.

Because the dermatologic surgeons that perform these procedures act as both the surgeon and the pathologist, they are able to complete these surgeries in just one day. In other methods, surgeons and patients may be required to wait several days before learning from a pathologist whether any cancerous tissue remains around the surgical site.

“We’re able to process the tissue, look at it within an hour, evaluate it and then take more, if necessary,” Tschetter said. “We don’t move onto the repair until we know we’ve gotten the entire tumor.”

It’s highly successful.

Mohs surgery is speedy and efficient, but also one of the most effective forms of treating certain types of skin cancer. For a standard skin tumor that’s being treated for the first time, the success rates are as high as 98 to 99 percent. “This type of surgery offers one of the best cure rates for skin cancer,” Tschetter said.

Mohs surgery is basically painless.

Apart from the injection of an anesthetic to numb the area prior to the procedure, patients will be experience very little pain during or afterward. If patients are anxious about the procedure, our dermatologic surgeons can give them an oral medication in addition to the anesthetic to help them relax on the day of their Mohs surgery, Tschetter said. “Typically, pain after the procedure is minimal and is typically relieved by over-the-counter medications like Tylenol or Advil,” Tschetter said. “Many patients tell me they didn’t need anything, because they didn’t experience any pain after leaving the clinic.”