Dermatology

Mohs Micrographic Surgery at Boston Medical Center

What is Mohs Micrographic Surgery?

Mohs micrographic surgery is a technique for removal of skin cancers. Mohs surgery is unique because it allows the surgeon to map and remove not just the visible parts of a skin cancer, but also the roots that can only be seen under the microscope. When used to treat basal cell carcinoma and squamous cell carcinoma, Mohs has the highest cure rate of any treatment. This technique also allows the Mohs surgeon to spare normal skin to minimize scarring.

Originally developed by Frederic E. Mohs in the 1930s, this technique has been refined and improved over several decades.

How is Mohs Micrographic Surgery done?

Mohs micrographic surgery is done in stages. After the site is cleaned and numbed, the Mohs surgeon will remove the visible portion of the tumor together with a very small margin of normal skin. The tissue is then processed in the laboratory and viewed under the microscope by the Mohs Surgeon. Within approximately one hour the surgeon will have determined whether the tumor is completely removed or whether it is necessary to remove additional tissue. The Mohs surgeon is able to carefully map out the area where the tumor remains and will only remove additional skin in the areas where the margin shows tumor. This process is repeated as many times as necessary to ensure that the tumor is completely removed.

After the tumor is removed, how will the area be repaired?

Once the margins are clear the surgeon will determine which repair will give the best cosmetic outcome and restore normal architecture and function. In some cases the best repair is a simple straight line while in other cases the best repair may require shifting and re-draping skin (flaps) or borrowing skin from a distant site such as the skin over the collar-bone or the skin fold in front of the ear (grafts). Often a great many stitches are required to create the repair that will ultimately give the best appearance once the site is healed.

Treatment Cure Rates

Clinical studies demonstrate that Mohs micrographic surgery provides five-year cure rates of approximately 99% for new basal cell carcinomas, and 96% for recurrent basal cell carcinoma. Cure rates for squamous cell carcinoma are approximately 97%.These cure rates are significantly higher than with other methods of tumor removal or destruction.

When is Mohs micrographic surgery preferred to other treatments?

• Tumors on the face
• Tumors on other body sites that may be difficult to repair if too much tissue is removed.
• Recurrent (previously treated) tumors
• Large tumors or tumors without clearly defined edges
• Tumor that appear aggressive under the microscope

Who will be performing my surgery at Boston Medical Center?

Deborah Cummins, MD, Director of Mohs and Dermatologic Surgery at Boston Medical Center performs all Mohs surgical cases with the assistance of her specially trained team, which includes surgical assistants, resident physicians, and a technician that processes the tissue in the laboratory.

Dr. Cummins graduated from Brown University and received her medical degree from Johns Hopkins School of Medicine with academic honors including membership in Phi Beta Kappa and Alpha Omega Alpha Honor Societies. She completed her internship in internal medicine at Johns Hopkins-Bayview Medical Center and residency in dermatology at Harvard Medical School-Massachusetts General Hospital. She also received fellowship training in Mohs Dermatologic Surgery and Cutaneous Oncology at Tufts Medical Center.

Board certified in dermatology, Dr. Cummins is also a member of the American College of Mohs Surgery and the American Academy of Dermatology. Her clinical and research interests include surgical dermatology and skin cancer. She is the author of multiple publications related to surgical reconstruction, basal cell carcinoma, tanning and melanoma.