Home » Skin Cancer & Mohs Surgery
Bend Dermatology offers Mohs surgery for skin cancer at its Central Oregon locations. We were the first practice to offer it in the area and our Fellowship-Trained Surgeon who performs the Mohs procedure is Dr. Mariah Johnson.

What is Mohs Surgery?

Mohs micrographic surgery is a specialized procedure for the microscopically controlled removal of skin cancers. Known as the single most effective technique for removing basal and squamous cell carcinomas, Mohs surgery has a cure rate of up to 99%. By microscopically examining the tissues removed during the surgery, it eliminates the need to estimate how much to cut and how deep the tumor’s roots go. Thus, Mohs surgery can remove all of the cancerous cells while sparing as much healthy tissue as possible. It is also ideal for highly visible skin cancer on the head and neck since it results in minimal scarring.The layer-by-layer removal and identification process allows our Mohs surgeon to more effectively remove cancerous skin tissues. Mohs surgery is a form of treatment developed in the 1930s by Dr. Frederic Mohs which combines the surgical removal of cancerous tissues along with the immediate microscopic examination of the tumor and underlying roots. 

Mohs Skin Cancer Surgery in Seven Steps

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STEP 1: The cancer is first curetted by the Mohs surgeon to get a feel for how deep and wide it extends. A scalpel is then used to excise a 1-2mm margin around the curetted tumor. Hash marks are made at 12 o’clock, 3 o’clock, and 6 o’clock to maintain orientation of the skin. Care is taken to cut a 45-degree angle around the skin edges.
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STEP 2: Colored ink is used to maintain orientation of the skin (green is from 9 to 12 o’clock, red is from 12 to 3 o’clock).
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STEP 3: An anatomical map is drawn to display the location and orientation of the excised skin. The map includes hash marks and symbols to notate the color of ink used (green = dashes, red = solid line).
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STEP 4: Our histotechs prepare the tissue by turning it into a frozen block and then slicing the block into very thin layers. These layers are then placed onto glass slides.
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STEP 5: The glass slides are then stained so that the tissue is more visible under the microscope.
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STEP 6: The Mohs surgeon reviews the slides under a microscope to see if any skin cancer cells extend to deep or peripheral edges of the tissue. In this case, the margins are clear, meaning there are no cancer cells extending to any of the edges.
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STEP 7: We celebrate when then the tissue margins are clear!

What to Expect with Mohs Surgery

Mohs surgery is done under local anesthesia and rarely requires hospitalization, yet it is recommended that only a Mohs Fellowship-Trained Doctor with the highest standards of quality and competency performs the surgery. Mohs has a superior cure rate for skin cancer and is often performed after a prior treatment has failed. However, it is important to emphasize that no method at any time, including the Mohs treatment, can promise 100% cure rates.Mohs surgery also cuts out the minimum necessary amount of normal skin needed for a high cure rate (95 to 99%), which is especially important in critical and sensitive areas. Once a tumor has come back, conventional treatments such as cutting out, scraping and burning, radiation only offer approximately a 50% cure rate. Though it can be a time-consuming process, Mohs surgery is worth the effort in order to get all cancer out while retaining as much healthy tissue as possible.The process our Bend Dermatology Fellowship-Trained Mohs surgeon uses during the procedure includes:

  1. Examining the roots of skin cancer. The roots may extend beyond the visible portion of the tumor, like the tip of an iceberg. If these roots aren’t removed, cancer will likely recur.
  2. Removing the visible portion of the skin cancer surgically.
  3. After removing the tissue, it is color-coded with a dye, divided into sections, and a map is drawn.
  4. Examining the undersurface and edges of the tissue under a microscope in order to ensure that all the skin cancer is out.
  5. If all of the skin cancer isn’t out, marking the exact area on the map where it persists to return to remove another layer of skin from precisely where the cancer cells remain. 

The Mohs surgery removal process continues until there is no longer any evidence that skin cancer remains. At this point, the Mohs surgeon will close the wound with the least scarring and best cosmetic results possible.

What Types of Skin Cancer Does Mohs Surgery Treat?

Basal cell carcinoma and squamous cell carcinomas are the types of skin cancer most commonly treated with Mohs surgery. Skin cancers can, and often do, destroy the skin and structures where they grow and can be fatal if left untreated. However, skin cancers treated with Mohs surgery usually do not spread to other parts of the body and cause death.Skin cancer will not go away on its own and while it may seem to heal over time, if untreated, they always come back bigger, and with deeper roots. While the removal of skin cancer is not an emergency, it should be removed within a month or two of diagnosis. Read more about skin cancer here.

Does My Insurance Pay for Mohs Surgery?

In most cases, your medical insurance will cover Mohs surgery though you will be responsible for any deductible and copayment required by your policy. We like to arrange for your insurance company to reimburse us directly if possible. If paying for your Mohs surgery is a hardship, please let our Bend Dermatology team know, and we will work out an alternative payment plan. Additionally, if you are a Medicare enrollee, you should mention any special supplemental policies to our team when you visit one of our offices. It’s also a good idea to bring all health insurance cards and policy numbers with you when you come in for your appointment. Read more about Insurance information here.