Mohs Micrographic Surgery (MMS) is a highly specialized technique developed for the precise removal of skin cancer. This procedure offers the highest cure rates for common skin cancers, such as basal cell and squamous cell carcinomas, while preserving the maximum amount of healthy tissue. By using immediate microscopic analysis, the surgeon can trace and remove the cancer’s roots in a single, staged procedure. Understanding who performs this delicate work requires looking at the specific medical training and collaborative team responsible for the entire process.
The Dermatologic Surgeon
The Dermatologic Surgeon is the primary medical professional performing Mohs surgery. This individual undertakes a unique dual responsibility during the procedure, acting as both the surgeon and the pathologist. They meticulously remove a layer of cancerous tissue, which is then immediately prepared for examination in an on-site laboratory. This singular authority over both the excision and the microscopic analysis defines the procedure’s precision.
Using a specialized mapping technique, the surgeon orients the excised tissue to precisely identify the location of any remaining cancer cells. They examine the frozen tissue sections under a microscope to ensure that all tumor margins are clear before closing the wound. This immediate margin control eliminates the waiting period common with traditional pathology, ensuring complete removal of the malignancy while the patient waits.
Specialized Training and Fellowship Requirements
The path to becoming a qualified Mohs surgeon begins with completing a residency in dermatology. Following residency, the physician must complete a rigorous one- to two-year fellowship in Micrographic Surgery and Dermatologic Oncology. These fellowship programs are accredited by recognized bodies, such as the Accreditation Council for Graduate Medical Education (ACGME) or the American College of Mohs Surgery (ACMS).
Accredited training ensures mastery of both surgical excision and the complex dermatopathology required for the procedure. Fellows must participate in at least 500 Mohs micrographic surgeries as the primary surgeon. This experience includes performing excisions, interpreting tissue slides, and executing necessary reconstructions. The curriculum includes advanced training in complex cases and reconstructive techniques.
The Essential Support Team
Mohs surgery relies on a specialized clinical team working alongside the surgeon. The most specialized member of this support staff is the Mohs histotechnologist, or Mohs histotech. This laboratory professional is responsible for the rapid and precise processing of the excised tissue specimens.
The histotechnologist prepares the tissue by placing it in a cryostat, a freezing machine that allows for ultra-thin sectioning. These sections, typically four to six micrometers thick, are stained (usually with hematoxylin and eosin, or H&E) and mounted onto slides. This preparation must be executed quickly and accurately to ensure the surgeon has slides for microscopic review within minutes.
Surgical nurses and administrative staff complete the team, managing patient care, preparing the sterile surgical environment, and coordinating the flow of the staged procedure.
Coordination with Reconstructive Specialists
After the cancerous tissue is removed and the margins are clear, the resulting surgical wound (the defect) must be repaired. Mohs surgeons are trained to perform most of these reconstructions, including simple linear closures, local flaps, and skin grafts. Fellowship programs require fellows to perform a high volume of reconstructions, often exceeding 500 cases as the primary surgeon.
For larger or cosmetically sensitive defects (e.g., eyelids, nose, or ears), the Mohs surgeon may coordinate closure with other specialized surgeons. These professionals include Plastic Surgeons, Oculoplastic Surgeons, or Otolaryngologists (Head and Neck Surgeons). This multidisciplinary approach ensures that the patient receives the optimal functional and aesthetic outcome for the repair.