There are five standard methods for the treatment of skin
cancers. The two nonsurgical treatments are cryotherapy (deep
freezing) and radiation therapy. The three surgical methods
include simple excision, physical destruction (curettage with
electrodesiccation) and Mohs Micrographic Surgery.
After the removal of the visible portion of the tumor by
excision or curettage (debulking), there are two basic steps
to each Mohs Micrographic Surgery stage. First, a thin layer
of tissue is surgically excised from the base of the site. This
layer is generally only1-2 mm larger than the clinical tumor.
Next, this tissue is processed in a unique manner and examined
under the microscope. On the microscopic slides the doctor examines
the entire bottom surface and outside edges of the tissue. (This
differs from the frozen sections prepared in a hospital setting
which, in fact, represent only a tiny sampling of the tumor margins.)
This tissue has been marked to orient top to bottom and left to right.
If any tumor is seen during the microscopic examination, its location
is established, and a thin layer of additional tissue is excised from
the involved area. The microscopic examination is then repeated. The
entire process is repeated until no tumor is found.
Mohs Micrographic Surgery allows for the selective removal of
the skin cancer with the preservation of as much of the surrounding
normal tissue as is possible. Because of this complete systematic
microscopic search for the roots of the skin cancer, Mohs
Micrographic Surgery offers the highest chance for complete removal
of the cancer while sparing the normal tissue. The cure rate for
new basal cell and squamous cell carcinomas exceeds 97%. As a result,
Mohs Micrographic Surgery is very useful for large tumors, tumors with
indistinct borders, tumors near vital functional or cosmetic structures,
and tumors for which other forms of therapy have failed. Although no
surgeon or technique can guarantee 100% chance of cure, the Mohs
technique enjoys the highest cure rate of all treatments for selected