The ACMS – Mohs Surgery: The Most Effective Treatment for Skin Cancer

What is Mohs Surgery?

Originally developed in 1938 by Dr. Frederic Mohs at the University of Wisconsin, Mohs micrographic surgery has been refined into the most advanced, precise, and effective treatment for an increasing variety of skin cancer types. With the Mohs technique, physicians can precisely identify and remove an entire tumor while leaving the surrounding healthy tissue intact and unharmed. Mohs surgery offers the highest potential for cure – even if the skin cancer has been previously treated by another method.

Dr. Thomas is a leader in the treatment of skin cancer. After completing his Mohs Surgery fellowship at the University of Michigan in 1987, he served on the faculty of the Department of Dermatology at UAB until 1990. Dr. Thomas has been in private practice in Birmingham since 1990.

The Thomas Skin Surgery Mohs Surgical Team

preparing for surgery
Surgeons performing surgery
Lab technician examines cell using microscope

Dr. Thomas, who heads the team, had subspecialty surgical training during his fellowship in Mohs surgery at the University of Michigan and he is recognized as a Fellow by the American College of Mohs Surgery. Other physicians on the “team” may include fellows and residents who assist while learning the technique. The nurse is an important part of the team who will help answer your questions, respond to your anxieties, assist in surgery and instruct you in dressings and wound care after the surgery is performed. A lab technician, performs the essential task of preparing the tissue slides, which are examined under a microscope by Dr. Thomas.

Mohs Surgery: What The Patient Should Expect

Removal and Slide Preparation

The surgery is performed as follows: the skin suspicious for cancer is treated with a local anesthetic so that there is no feeling of pain in the area. To remove most of the visible skin cancer, the tumor is scraped using a sharp instrument called a curette. A thin piece of tissue is then removed surgically around the scraped skin. The wound is inspected after removal of the specimen and any bleeding that is encountered will be stopped by one of several methods; direct pressure, electrocautery (electric needle) and occasionally a small blood vessel is encountered which must be tied using suture material. A pressure dressing is then applied, and the patient is asked to wait while the slides are being prepared.

Skin tumor

Microscopic Assessment

Processing the specimen demands maintaining precise orientation of the specimen as it relates to the patient. The specimen is carefully divided into pieces that will fit onto a microscope slide; the edges of the specimen are marked with colored dyes; a careful map or diagram of the tissue removed is made; and the tissue is embedded in a suitable medium (OCT) and frozen by the technician. Thin slices can then be made from the frozen tissue, stained and then examined by Dr. Thomas at the microscope. The removal of each layer of tissue, its processing in the lab as well as the microscopic assessment by Dr. Thomas takes approximately one hour.

Laboratory Technician looking though microscope

After Mohs Surgery

At the end of Mohs Surgery, you will be left with a surgical wound. This wound will be dealt with in one of several ways. The several options will be discussed with you in order to provide the best possible functional and cosmetic results The possibilities explained below include: (1) healing by spontaneous healing (second intention); (2) closing the wound, or part of the wound, with stitches; (3) using a skin graft; (4) using a skin flap; or (5) arranging a consultation with a plastic surgeon who specializes in more complicated surgical repairs. Visit the Mohs College website and their FAQ page to learn more.

Old man wearing sun glasees with bandage on his right temple after surgery

Patient Information & Education

Find more information about Mohs Surgery and Skin Cancer in the following topics below.