Overview

Mohs Surgery is a specialized surgical technique for skin cancer removal with microscopic margin control to ensure complete excision.

Mohs surgery is crucial for treating high-risk skin cancers, providing the highest cure rates while preserving healthy tissue.

Learn more in our comprehensive RxDx Dermatology Course

Indications

✓
Basal Cell Carcinoma

High-risk BCC

✓
Squamous Cell Carcinoma

High-risk SCC

✓
Melanoma

Lentigo maligna

✓
Recurrent Tumors

Previously treated

✓
Cosmetically Sensitive Areas

Face, hands, feet

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Metastatic disease

Relative Contraindications

✗ Bleeding disorders
✗ Anticoagulation therapy

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient assessment, tumor evaluation, informed consent, and understanding Mohs technique.

Step-by-Step Procedure

Step 1: Tumor Assessment

Evaluate tumor characteristics.

⚠️ Common Mistakes to Avoid:

  • Incomplete assessment
  • Wrong diagnosis

💡 Pro Tip:

Confirm diagnosis.

Step 2: Anesthesia

Administer local anesthesia.

⚠️ Common Mistakes to Avoid:

  • Inadequate anesthesia
  • Wrong technique

💡 Pro Tip:

Ensure complete numbness.

Step 3: Initial Excision

Remove visible tumor.

⚠️ Common Mistakes to Avoid:

  • Inadequate margins
  • Poor technique

💡 Pro Tip:

Use proper technique.

Step 4: Tissue Processing

Process tissue for microscopy.

⚠️ Common Mistakes to Avoid:

  • Poor orientation
  • Artifacts

💡 Pro Tip:

Maintain orientation.

Step 5: Microscopic Analysis

Analyze margins.

⚠️ Common Mistakes to Avoid:

  • Missed tumor
  • Poor interpretation

💡 Pro Tip:

Thorough analysis.

Step 6: Additional Stages

Remove residual tumor.

⚠️ Common Mistakes to Avoid:

  • Incomplete removal
  • Excessive tissue

💡 Pro Tip:

Remove only involved tissue.

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Post-procedure Care

Post-procedure care involves wound care, reconstruction planning, and monitoring for recurrence.

Complications & Management

Complication Incidence Signs Management Prevention
Bleeding 5-10% Excessive bleeding Pressure, sutures Proper technique
Infection 2-5% Redness, pain, discharge Antibiotics Sterile technique
Scarring 20-30% Visible scar Time, scar care Proper technique
Recurrence 1-5% Tumor returns Repeat Mohs Complete excision

Clinical Pearls

💡

Always confirm diagnosis before Mohs surgery.

🎯

Maintain tissue orientation throughout.

⚡

Analyze margins thoroughly.

🔍

Document all stages clearly.

📊

Plan reconstruction carefully.

🎨

Consider cosmetic outcome.

⚠️

Monitor for complications.