Mohs surgery (Mohs micrographic surgery) is a skin cancer treatment technique developed by Dr. Frederic Mohs at the University of Wisconsin in the 1930s that differs from other skin cancer treatments by performing the immediate and complete microscopic examination of removed cancerous tissue that is methodically excised so that the entire cancerous tissue can be removed while saving normal tissue. Mohs surgery involves the surgical removal of tissue, tissue analysis, and reconstruction of the surgical site, all in one visit to the surgeon. Mohs surgery has the highest reported cure rate for skin cancer.
Because some skin cancers can be more extensive than they appear, with “roots” in the skin, along blood vessels, or along cartilage, and with some recurring skin cancers sending out extensions deep under scar tissue at the excision site, Mohs surgery is specifically designed to track and remove the cancerous roots. Because Mohs surgery is designed to remove all of the cancer and roots, it is difficult to predict ahead of time how much tissue will have to be removed and how large the skin defect will be after the surgery.
Mohs surgery is most appropriate for skin cancers involving the nose, eyelids, hairline, lips, ears, hands, feet, and genitals where an important consideration is the preservation of the maximum amount of healthy tissue for cosmetic or functional purposes. Mohs surgery is often employed for recurrence of cancer or for cancers that are at high risk for recurrence. Most Mohs surgery cases can be completed in three or fewer stages that take less than four hours, although more stages may be required that take more time (i.e., tissue is removed, the tissue is properly prepared for examination, examined under a microscope, roots of cancer identified and mapped, and if residual cancer is found, additional cancerous tissue is removed, after which the process is repeated until no remaining cancer is found and the surgical defect is repaired).
Mohs surgery is typically performed in the physician’s office and is best performed by physicians properly trained and experienced in performing Mohs micrographic surgery.
In a study published online in the medical journal JAMA Dermatology on February 4, 2015 that investigated medical malpractice claims involving Mohs surgery between 1989 and 2011, the investigators found 42 cases of Mohs medical malpractice claims, of which 26 involved non-Mohs surgeons as the primary defendants. Of those 26 claims, 16 alleged delay in diagnosis or failure to diagnose, 8 involved cosmetic outcome issues, 7 claimed lack of informed consent, and 6 claimed a delay in referral or the failure to refer to a Mohs surgeon. In the 16 medical malpractice claims against Mohs surgeons, 5 alleged the lack of informed consent and 4 involved cosmetic outcome issues. The medical malpractice plaintiff won against the defendant Mohs surgeon in only one case.
The study’s authors concluded, “Closer coordination between non-Mohs surgeons and Mohs surgeons may help minimize risk to both parties and lead to better patient care.”
If you or a family member may have a medical malpractice claim involving Mohs surgery in the United States, you should promptly find a Mohs surgery malpractice lawyer in your state who may investigate your Mohs surgery claim for you and represent you in a Mohs malpractice case, if appropriate.
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