a cross section of a cancerous mole with a dotted line showing where the cancer will be cut out

A Mohs By Any Other Name

When giving directions to a friend who was taking me to a doctor’s appointment, I told him it was at the hospital where I got my last Mohs. He was confused.

“What?” he asked.

I repeated what I had said. Then I realized that he didn’t know what Mohs was. I had forgotten that shorthand which is familiar to many in skin cancer land will not ring a bell for others.

What is Mohs surgery, anyway?

Before I got my first Mohs, – in which a surgeon removed skin cancer layer by layer – I didn’t know was it was either. When I heard the word, I thought of the jazz musician Mose Allison. Mohs, Mose, they sound the same but are spelled differently. OK class, what is the name for these two M words? It’s a homophone: a word that has the same sound as another word but is spelled differently and has a different meaning.

I pointed to my nose. That’s where a Mohs surgeon recently removed a squamous cell cancer. He was even more confused. “Nose?” he asked.

No, Mohs! It felt like we were playing “Who’s on First?”

A big fat red one

My mother liked this rhyme: When they were giving out noses, I thought they said roses, so I said “I’ll have one big fat red one.”

Seriously, that’s how my nose felt after removal of a squamous cell cancer with the Mohs technique. But now there isn’t even a scar. The areas where I had it done on my lip, cheek, and eyelid have also blended in, though if you look closely you can see a faint scar. The one on my ankle has a larger scar because it needed a graft. It kind of looks like a little sand dollar. That’s fine with me. At one time it looked like a gaping wound that I thought would never heal.

The history of Mohs

If you don’t already know, I hope the suspense isn’t killing you. Some people think Mohs is an acronym, but it is really referring to Dr. Frederic Mohs, Professor of Surgery at the University of Wisconsin. He developed the surgical technique in the 1930s.

“The goal of Mohs surgery is to remove as much of the skin cancer as possible, while doing minimal damage to surrounding healthy tissue. Mohs surgery is usually done on an outpatient basis using a local anesthetic,” the Mayo Clinic explains.1

“Mohs surgery is an improvement to standard surgery (local excision), which involves removing the visible cancer and a small margin of surrounding healthy tissue all at once. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery."1

Getting skin cancer by the roots

According to the American College of Mohs Surgery, “Mohs recognized that a skin cancer often resembles the "tip of the iceberg" with more tumor cells growing downward and outward into the skin like the roots of a tree. These roots are not visible with the naked eye, but can be seen under a microscope.”1

Most patients sit in the waiting room while the doctor examines the specimen to see if another pass is needed. When I had my first one done, right near my tear duct, I got to stay in the procedure room. I lay back and closed my eyes. I needed two passes for a couple of mine, but for the others, I only needed one. I was more worried about the needle going in for the anesthesia than I was about the procedure. But the doctor did it with such tiny pinpricks that I hardly felt it.

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