|
|
|
Mohs
Micrographic Surgery Defined |
|
| What
Is Mohs Micrographic Surgery? |
 |
Mohs
micrographic surgery is named after its inventor, Dr.
Frederic Mohs of the University of Wisconsin. It involves
surgical excision of cancer containing tissue and systematic
microscopic examination of all cut surfaces that are
correlated with a drawn map of the wound (hence the
term "micrographic"). It is a highly specialized
procedure for the total removal of skin cancers. |
| |
|
| How
Is It Performed? |
|
| This
method involves five separate steps: (1) removal of
the bulk of the cancer with a skin scraper (a curette),
(2) surgical removal of a thin underlying of tissue,
(3) drawing a map and preparing stained frozen tissue
sections, and (4) examination of the excised tissue
under the microscope. After the tissue is removed, it
is marked with two colored dyes to distinguish the two
different skin edges. By doing this, we are able to
pinpoint the exact location of any remaining tumor during
the microscopic examination. If more cancer is found
on the microscopic examination, its location is marked
on the map (5), and the entire procedure (except step
1) is repeated, but only in the area of the remaining
cancer. Only by careful, systematic microscopic examination
of the removed skin can one be as certain as possible
that no cancer remains. |
|
| |
|
How
Does Mohs Micrographic Surgery Differ From Cancer Removal
In The Operating Room With "Frozen Sections"? |
|
| During
Mohs micrographic surgery, the tissue is examined in a different
and more thorough manner than is normally performed by a pathologist
associated with an operating room. Mohs micrographic surgery
examines the entire sides and undersuface of the excised tissue.
If one looks at a loaf of bread, Mohs micrographic surgery
examines the whole crust rather than a few slices of the loaf.
|
| |
|
| Who
Is Qualified To Perform Mohs Micrographic Surgery? |
|
Physicians
who are members of the American College of Mohs Micrographic
Surgery have taken one year of training in Mohs micrographic
surgery after a Dermatology Residency. According to CPT (Current
Physician Terminology) billing rules used by all insurance
companies, Mohs Micrographic Surgery "requries a single
physician to act in two integrated, but separate and distinct
capacities: surgeon and pathologist. If either of these responsibilites
are delegated to another physician... these codes are not
appropriate." Therefore, removal of skin cancer in the
operating room and having the tissue examined by a pathologist
is not Mohs micrographic surgery, and cannot
be billed as such. By law (CLIA, 1988), only dermatologists
and pathologists can interpret microscopic slides of skin. |
|
|
|
