Mohs Surgery - Controversy About Mohs Surgery

Controversy About Mohs Surgery

Few individuals argue about the cure rate for Mohs, especially pathologists familiar with the procedure. However, in recent years, a few authors suggested that Mohs surgery is no better than standard excision. The author in one study did not conclude the adequacy of the study as it is limited in size and short duration of the study (30 months). Extensive studies performed by Dr. Mohs involving thousands of patients with both fixed tissue and fresh tissue cases have been reported in the literature. Other surgeons repeated the studies with also thousands of cases, with nearly the same results.

Clinical 5 year cure rates with Mohs surgery:

1. 4085 cases of primary and recurrent cancer of face, scalp, and neck. Cure rate of 96.6%.
2. 1065 cases of squamous cell carcinoma of face, scalp, and neck – cure rate 94.8%
3. 2075 cases of basal cell cancer of the nose both primary and recurrent, cure rate 99.1%.
4. Cure rate for basal cell cancer of the ear, less than 1 cm, 124 cases, cure rate 100%.
5. Cure rate of basal cell cancer of the ear, 1 to 2 cm, 170 cases, 100%. One needs to keep in mind that the cases performed by Dr. Mohs were for large and extensive tumors, often treated numerous times before by other surgeons. Regardless, his cure rate for small primary tumors either were 100% or near 100% when separated out from larger or recurrent tumors.

Experienced Mohs surgeons have reported cure rates for melanoma-in-situ from 95% to 98% (depending on if it is small MIS, or lentigo maligna variant), much higher than previously reported by Dr. Mikhail of 77%.

These are only a small number of cases reported by Dr. Mohs, and numerous other articles by other authors have shown tremendous cure rates for primary basal cell carcinoma. However, with studies by Smeet, et al. showing a Mohs cure rate of about 95%, and another study in Sweden showing Mohs cure rate of about 94%; we really have to question if methodology practiced by Mohs surgeons around the world is of the same standard. Some surgeon also question if the standard 2 sections performed by some Mohs surgeons is adequate to control for false negative Mohs reports, as many surgeons prefer serial sectioning of multiple Mohs histology layers.