The physician removes the bulk of the tumor with a curette or scalpel and then removes very thin layers of the remaining surrounding skin one layer at a time. Each layer is then immediately checked under a microscope while the patient waits; and the procedure is repeated until the last layer viewed is cancer-free. Therefore there is no waiting on pathology results; since the pathology is done with frozen sectioning in the office.

The wound is then typically repaired right afterwards (as with standard excision). This technique saves the greatest amount of healthy tissue and may reduce the rate of local recurrence. It is often used for tumors that have recurred or are in hard-to-treat places such as the head, neck, hands, and feet. It is mostly used for non-melanoma skin cancer (BCC and SCC) but is being used increasingly for melanoma in certain situations and locations.

The main disadvantage is the wait times on the day of surgery; since multiple layers may need to be evaluated to ensure complete but accurate eradication of the tumor. It also requires offices with a certified lab, special equipment and a highly trained Mohs surgeon familiar with the technique to ensure the extremely high cure rates.

Not all Dermatology offices have this capability; but here at ASLC, both of our Dermatologists are highly skilled and trained Mohs surgeons!