So you want to be a Mohs surgeon?

Mohs micrographic surgery (MMS) is a highly specialised surgical technique performed by dermatologists under local anaesthesia and used for the treatment of complex skin cancers. The technique was first developed by Frederic Mohs in the 1930s. The process involves taking horizontal sections of skin tissue which are then carefully mapped, colour-coded and examined microscopically in real-time. This technique differs from other surgical excision techniques which involve examination of vertical sections. During the process of MMS, 100% of the tissue margins are evaluated to ensure that the tumour is completely clear prior to repair of the skin defect. It therefore results in the highest cure rates for complex skin cancer (up to 99%) and minimises removal of normal tissue. Depending on the size of the defect post MMS, there are often several repair options available which should be discussed with the patient for most satisfactory results. These include; secondary intention healing, direct linear closure, use of a local skin flap or skin graft repair. MMS is recognised as the gold standard treatment for high-risk basal cell carcinoma (BCC). ‘High Risk’ BCCs have a greater risk of recurrence and are typically located on the central face, periorbital region, nose, lips and ears, where it is essential to preserve function and cosmetic appearance. It is also indicated for other aggressive skin tumour types including; squamous cell carcinoma, dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, lentigo maligna and extramammary Pagets disease.