Why Mohs Training Matters for Skin Cancer Treatment

Specialized Training for Enhanced Patient Results

Mohs micrographic surgery represents the most effective approach to treating common skin cancers by painstakingly removing cancerous tissues layer by layer while examining the margins microscopically.

However, to realize these excellent outcomes, it is essential to choose a Mohs surgeon who has completed the rigorous fellowship training that produces expertise in this specialized procedure.

This article explores what makes Mohs micrographic surgery so effective, what training and certification are required, and how to identify a Mohs surgeon who can help you achieve the best results.

Mohs Micrographic Surgery

Mohs micrographic surgery is a specialized procedure to treat common types of skin cancer such as:

Skin Cancer TypeDescriptionBasal Cell CarcinomasArise from basal cells; most common skin cancers treated with Mohs surgery; need clear margins.

Squamous Cell CarcinomasArise from squamous cells; often require Mohs surgery for complete removal; aggressive potential.

Less Common Nonmelanoma Skin CancersIncluding Merkel cell carcinoma; treated with Mohs surgery when indicated; less common cases.

The goal of Mohs micrographic surgery is the complete removal of cancerous lesions with maximal tissue preservation and optimal cosmetic outcomes.

Effectiveness of Mohs Micrographic Surgery

Mohs micrographic surgery has demonstrated unparalleled effectiveness in treating common skin cancers due to its ability to meticulously map and remove cancerous lesions layer by layer until clear margins are achieved.

High cure rates

Mohs surgery achieves cure rates exceeding 99% for nonmelanoma skin cancers - significantly higher than with standard surgical excision. This is because Mohs uses real-time microscopic examination to guide incremental removals, ensuring that all cancerous tissue is excised.

Low recurrence rates

Recurrence rates after Mohs micrographic surgery are also exceptionally low at less than 2% for basal cell carcinoma and less than 5% for squamous cell carcinoma. The combination of real-time microscopic analysis and serial tissue excisions allows for thorough assessment and removal of cancerous lesions down to their roots.

The continuous feedback loop provided by microscopic examination after each excisional stage enables a Mohs surgeon to methodically and completely remove skin cancers while sparing all healthy tissue. This accounts for the excellent cure rates and minimal recurrence seen with Mohs micrographic surgery.

The technique's effectiveness in maximizing tumor clearance makes it the treatment of choice for many skin cancers, particularly when located in complex anatomic areas.

The Mohs Micrographic Surgery Procedure

Mohs micrographic surgery utilizes a distinctive, precise technique to maximize the removal of cancerous tissue while sparing healthy tissue.

Precise technique

A Mohs surgeon performs incremental excisions of a visible tumor plus a border of normal-appearing tissue. Each layer of tissue is frozen, sectioned, and examined microscopically while the patient waits. Only tissue found to contain cancer cells is subsequently excised, guided by visual maps and photographic documentation. This continues in stages until all margins are deemed clear of cancer.

Examination of tissue

After tissue is frozen and sectioned into slides, a pathologist or surgeon examines the slides under a microscope to identify cancerous cells. Any tissue containing suspicious cells is marked for further excision during the next stage.

Cancerous tissue removal

Based on the initial microscopic examination results, the surgeon performs further excisions targeting tissue specifically identified as containing residual cancer cells. This process continues in successive stages until all tissue slides show clear peripheral and deep margins.

Wound reconstruction techniques

Upon achieving clear margins, a Mohs surgeon skillfully closes the surgical site using techniques tailored to the defect size, depth, and location. This may involve simple closures, skin grafting, or complex flap procedures to optimize cosmetic outcomes.

The stepwise nature of Mohs micrographic surgery allows for the precise removal of cancerous lesions with maximal preservation of healthy tissue and functional structures.

Training and Certification for Mohs Surgery

Mohs surgeons attain the requisite skills and experience through various avenues of medical education, hands-on training, and certification.

1. Fellowship Training Program

The gold standard for Mohs micrographic surgery expertise is the completion of a two-year fellowship program specifically focused on Mohs surgery and dermatologic oncology. These rigorous programs provide extensive, comprehensive training on all technical aspects of performing Mohs surgery as well as managing complex reconstructions and complications. Graduates are considered experts and leaders in the field.

2. Residency training

While not sufficient on its own, dermatology residency includes training in basic Mohs techniques to allow non-fellowship graduates to perform standard Mohs surgeries. Additional hands-on courses and assistance from fellowship-trained surgeons may augment skills for more complex cases.

3. Technician training

Technicians perform important roles assisting in Mohs surgeries by trimming and inking tissue, sectioning specimens, mapping tissue locations, and closing surgical sites. Dedicated training programs teaching structured curricula produce highly skilled technicians who boost surgeon efficiency and precision.

Practice Settings for Mohs Surgery

Mohs micrographic surgery is performed in a variety of medical settings by fellowship-trained dermatologists and dermatologic surgeons.

Academic centersMany academic medical centers, teaching hospitals, and large dermatology practices employ Mohs surgeons to treat skin cancer patients. These institutions offer state-of-the-art care alongside resident and fellow training programs.
Private dermatology practices	Solo and group dermatology practices also commonly offer Mohs micrographic surgery performed by board-certified dermatologists who have completed fellowship training in Mohs surgery. These office-based settings offer convenience for patients requiring routine and more complex skin cancer treatments.

Certifying Organizations for Mohs Surgeons

Several credentialing organizations establish standards for training and certifying physicians who perform Mohs micrographic surgery.

American College of Mohs Micrographic Surgery

The ACMS is the main certifying body for Mohs micrographic surgeons. Fellowship training and case experience requirements must be met along with ongoing continuing education. Certification signifies expertise and adherence to standards developed by the ACMS.

American Society for Dermatologic Surgery

The ASDS also provides certification for dermatologists performing Mohs micrographic surgery. Requirements include fellowship training and maintenance of high professional standards. Certification validates surgeons' proficiency and competence in performing Mohs procedures.

Continuing Education for Mohs Surgeons

Ongoing continuing medical education is essential for Mohs micrographic surgeons to maintain and enhance their expertise. Several options provide specialized instruction and hands-on training.

Workshops

Short workshops focused on Mohs surgery technique, reconstruction, and case-based learning offer updated information to practicing Mohs surgeons. These intensive courses typically feature expert faculty and ample time for skills practice.

Instructional time

Fellowship training programs require extensive instructional time dedicated to didactics, discussions, and hands-on case participation beyond the surgical exposures fellows primarily perform. This in-depth, structured education reinforces technical competency and knowledge retention.

Fellowship programs

For surgeons seeking advanced skills, repeat or refresher fellowships provide intensive, prolonged training equivalent to initial Mohs surgery fellowships. Refocused didactics and advanced surgical experiences refine capabilities and techniques.

Choosing a Mohs Surgery Provider with the Right Training

The level of training and experience of your Mohs micrographic surgeon is critically important for achieving optimal outcomes. Fellowships from accredited programs like the American College of Mohs Micrographic Surgery provide surgeons with the extensive, specialized training required to perform complex Mohs surgeries and reconstructions.

For best results, choose a provider with a demonstrated commitment to Mohs micrographic surgery through formal fellowship training. At Dermatology and Skin Health, our Mohs surgery doctors have completed rigorous training, allowing us to offer patients the highest cure rates, lowest recurrence risks, and best cosmetic results.

If you have questions about finding a Mohs surgeon with the right training and expertise for your skin cancer, please contact us. 

You may also book an online appointment with us to jumpstart your Mohs journey!