Dr. Joan Ramón Garcés Gatnau is a dermatologist and belongs to Top Doctors, the select circle of top doctors in Spain. As an expert in mohs surgery, he will explain the details of this intervention.
What does Mohs surgery treatment consist of?
Mohs micrographic surgery, also called Mohs surgery, is a technique for the removal of skin tumors that gives us the highest cure rate today. It consists of a staged excision surgery in such a way that we remove the tumor and look at its margins under the microscope until we find that we cure the tumor in its entirety. This technique gives us a higher cure rate than other conventional surgery techniques or destructive techniques such as radiotherapy, photodynamics, laser, etc… First we remove the tumor, cut it into small portions and stain them for identification. These portions are processed in a cryostat and cut into thin slices so that they can be viewed under the microscope. If tumor cells are observed under the microscope, they can be identified and marked on the graph corresponding to what would represent the lesion caused by the tumor. The surgeon sees exactly where there is tumor and in a second stage, if necessary, this lesion is removed only where there is tumor. The second stage proceeds in exactly the same way, the part is analyzed, cut up, colored and looked at again under the microscope. If in this second stage there is tumor again, a third stage must be done, if in this second stage we have the tumor free then we can conclude the Mohs surgery.
When is it necessary to resort to Mohs surgery?
Mohs surgery is especially indicated for tumors that have already been treated previously, tumors that are wrongly called recurrent, because in fact they are tumors that persist after the first intervention. It is also indicated in those tumors whose margins are poorly defined, we do not see them clear for classic excision. Or in those invasive, infiltrating tumors, whose histology will tell us that we will have problems with them. Mohs surgery is used for very conflictive tumors also due to their location, risk situations such as the lips, Mohs surgery gives us higher cure rates than other techniques. In fact, all the circumstances in which we have to operate a tumor by Mohs surgery are united, they merge together since persistent tumors are usually ill-defined tumors, they are usually aggressive tumors, they are usually located in risk areas.
How is the wound treated?
It will depend a lot on the wound that remains after Mohs surgery. It can be a superficial wound, a deep wound, a penetrating wound, an extensive wound. It will also depend on where it is located. In many cases, if the wound is small and superficial, it can be left to heal by second intention, the wound heals by itself. If the wound is extensive and large we will have no choice but to make a skin graft. But most of the time the wound is closed by the movement of the surrounding skin, either directly, which would be a direct closure, or with local flaps mobilizing the skin that we have around to achieve the maximum aesthetic effect in the healing of the wound.