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 Developed by Frederic E. Mohs, M.D. in the 1930s, Mohs Micrographic Surgery for the removal of skin cancer is a highly precise, highly effective method that excises not only the visible tumor but also any "roots" that may have extended beneath the skin surface. Five-year cure rates have been demonstrated up to 99 percent for first-treatment cancers and 95 percent for recurring cancers.
Mohs surgery involves the systematic removal and microscopic analysis of thin layers of tissue at the tumor site until the last traces of the cancer have been eliminated. The immediate and complete microscopic examination and evaluation of excised tissue is what differentiates Mohs surgery from other cancer removal procedures. Only cancerous tissue is removed, minimizing both post-operative wound size and the chance of recurrence.
Mohs surgery is most commonly used for basal and squamous cell carcinomas, although it can be recommended for the eradication of other cancers such as melanoma. Cancers that are likely to recur or have already recurred are often treated using this technique because it is so thorough. High precision makes Mohs surgery ideal for the elimination of cancers in cosmetically and functionally critical areas such as the face (nose, eyelids, lips, hairline), hands, feet and genitals.
Mohs physicians are highly trained to function as surgeon, pathologist and reconstructive surgeon during the cancer removal process. They work in offices equipped with appropriate surgical and laboratory facilities, and are supported by Mohs-trained nursing and technical staff.
As with any surgery, there are risks. There may be temporary or permanent numbness or muscle weakness in the area. Other possible complications include tenderness, itching, shooting pains, and need for further surgery if skin flaps or grafts fail.
 Simple Surgical Excision - removal by cutting out the cancer; the skin is sewn together using cosmetic dermatologic surgical techniques. The specimen is examined under a microscope after the procedure to determine that all the skin cancer has been removed. - Electrodesiccation and curettage - removal by scraping or "curetting"; the base is burned or "cauterized" with an electric needle.
- Cryosurgery - removal by freezing the tissue with liquid nitrogen.
- Radiation therapy (x-ray), and laser surgery (using wavelengths of light) - removal by destroying the cancerous tissue.
- Topical Therapy - medications such as imiquimod and 5-fluorouracil applied to the skin; especially useful to treat superficial basal cell carcinoma.
 A skin biopsy for microscopic examination may be done to confirm the diagnosis. A variety of different treatment options can be used depending on the location of the tumor, size, microscopic characteristics, health of the patient, and other factors. Most therapies are relatively minor office-based procedures that require only local anesthesia. Surgical excision to remove the entire cancer is the most commonly used treatment. "Mohs" micrographic controlled surgery, a method which requires specialized training by dermatologic surgeons, can be used to remove the tumor while sparing as much normal skin as possible. Other dermatologic surgical procedures include laser surgery, cryosurgery (liquid nitrogen - frozen method), radiation therapy, and electrodesiccation and curettage which involves alternately scraping and cauterizing (burning) the tumor with low levels of electricity.
Surgical excision is recommended for certain benign (non-cancerous) skin lesions such as moles, cysts, lipomas and other unwanted benign skin growths. These procedures are performed in the office operating room. The area is numbed with a local anesthetic and the area is excised and sutured. Some other growths such as moles sometimes are treated with "shave" excisions where no sutures are needed.
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