Why is mohs surgery the gold standard for treating skin cancers?

High cure rate: Mohs surgery offers the highest cure rate of 99%. It is the only procedure by which the entire tissue specimen can be viewed under a microscope at the time of surgery to ensure complete removal of the entire cancer while also minimizing the amount of healthy tissue lost thus providing the best cosmetic outcome.

It is not: Mohs is controversial for melanomas and probably should not be done except for some early melanomas on the face (and then only by experts who have explained potential risks). It may be the gold standard for basal cell carcinomas in sensitive areas, but may be overkill for small basal cell cancers on the trunk or extremeties.

Highest cure rate!: Mohs micrographic surgery is the most effective and advanced treatment for skin cancer today. It offers skin sparing surgery with the highest potential for cure – even if the skin cancer has been previously treated by another method. Visit (http://www.Skincancermohssurgery.Org/mohs-surgery) to learn more.

In situ/lm: There is pretty good data on using mohs for melanoma in situ and lentigo maligna. We recently reviewed this: the operative management of melanoma: where does mohs surgery fit in? Authors chang kh, dufresne r jr, cruz a, rogers gs. Journal dermatol surg. 2011 aug;37(8):1069-79.

Nothing is better: The cure rate of mohs surgery just cannot be beat, so it has become the gold standard treatment for many skin cancers. It is time consuming and expensive, which makes it important to utilize it efficiently. There are recent guidelines that help clarify when mohs surgery might be appropriate: http://www.Aad.Org/education-and-quality-care/appropriate-use-criteria/mohs-surgery-auc.

Poorly differentiated = Bad: When good pathologists examine squamous cell carcinomas they will comment on how well differentiated the tumor is. Differentiation is what makes all the unique cells in our body. When cells become cancerous, they often lose this differentiation, and for most cancers, the less differentiated they are, the worse they are. So a poorly differentiated tumor is potentially more aggressive than a well differentiated one.

I disagree: It is appropriate for squamous and basal cell carcinomas. But i would never advise a patient with melanoma to undergo moh's surgery. Melanoma patients should be referred to a surgical oncologist trained in treatment melanoma.

Margins control: Mohs micrographic surgery is the gold standard for the treatment of squamous cell and basal cell carcinoma. This is because of how the tissue is processed so that nearly 100% of the margin is sampled. The process continues until clear margins are obtained during the procedure and only then is they wound repaired. It offers the smallest scar with the highest "cure rate.".