Dr. Frederic Mohs

 Step One: 

The surgeon marks out the visible tumour and locally anesthetizes the tissue. Microscopic disease is usually present surrounding the visible tumour.  

  Step Two:

After the area is properly anesthetized, the visible tumour is excised using a scalpel technique and sent to the lab for processing using frozen sections. The wound is bandaged during processing.

   Step Three: 

The tissue is taken and sectioned into blocks and numbered. This is sent to the lab and completed using frozen sections. The tissue blocks are oriented and mapped. The tissue sample is stained and ready for microscopic evaluation. Each block of tissue is processed and analyzed separately 

  Step Four: 

The surgeon analyzes the tissue under the microscope and documents the areas which are positive.

Step Five: 

Only areas which have shown to be positive for skin cancer will be removed during a second stage of tissue removal. 1 – 2 mm of tissue are removed with each stage. This process (steps 1-5) is repeated until all the margins are cleared. On average, this usually takes two to three rounds of tissue removal. 

  Step six:

 Once all the skin cancer has been removed, the Mohs Surgeon will then assess the defect and discuss with the patient the options available for reconstruction, which depends on the size and location, and may include the wound healing on its own, rotation of skin tissue or a skin graft. In most cases, the reconstruction happens on the same day as the removal but on occasion, the Mohs Surgeon may refer to another specialist for more complex reconstructions.