Mohs Surgery


Mohs surgery, also known as chemosurgery, is a surgical technique to remove skin cancer with microscopic control. To ensure clear margins, thin layers of the skin are removed one at a time (think of it like peeling an onion) until the skin cancer is entirely gone. This precise, histologic control of skin cancer removal allows for a higher cure rate when cancers are located in critical areas such as the nose, ears, eyelids, lips.

Mohs surgery takes place in an outpatient setting under local anesthesia. Clients are asked to wait between the removal of the layers while Dr. Retief processes and reads the histology slides.

Only dermatologists who have completed a fellowship in Mohs Micrographic Surgery (ACMS) along with extensive training in pathology and skin reconstruction are certified to perform Mohs surgery.

Dr. Retief was trained at one of the nation's top Mohs surgery fellowship programs through the Medical University of South Carolina. During her education, she completed over 2,000 procedures—more than 40% of which were highly-complex skin cancer cases.

Dr. Carla Retief is one of Nashville’s very best doctors. She is both a Mohs surgeon and cosmetic surgeon, and I have been under her care since she performed a Mohs surgical procedure on my face nine years ago.
— Attorney in Nashville, TN

Conditions suited for Mohs surgery include:

  1. Non-melanoma skin cancer (squamous cell carcinoma and basal cell carcinoma) in the T-zone area of the face such as the eyelids, nose, lips, and malar cheek area.
  2. Non-melanoma skin cancer of the ear and preauricular area (crease in front of the ear).
  3. Recurrent squamous cell carcinoma of the face and scalp.
  4. Any non-melanoma skin cancer greater than 2cm in size (excluding superficial basal cell carcinoma).
  5. Any perineural non-melanoma skin cancer.
  6. Any recurrent non-melanoma skin cancer.
  7. Any squamous cell carcinoma and basal cell carcinoma with an aggressive histologic growth pattern.
  8. Any squamous cell carcinoma and basal cell carcinoma in an anatomic location that requires tissue conservation for optical reconstruction.
  9. Squamous cell carcinomas in clients with immunosuppression.
  10. Radiation-induced squamous cell.
  11. Squamous cell carcinomas on the scalp and nail bed.
Advantages of Mohs surgery include a higher cure rate and potentially smaller post-surgery scarring. Disadvantages of Mohs include the tedious and prolonged nature of the surgery, and, in some cases, the inability to remove a large or difficult tumor in a single day.

Melanoma isn’t typically treated with Mohs surgery, as there is controversy over its effectiveness. Melanoma in-situ is the most superficial form of melanoma. As it is the most curable form of melanoma, it is sometimes able to be treated with Mohs surgery.

As Nashville’s best and most experienced Mohs surgeon, Dr. Retief will discuss the best treatment option for your skin cancer type. She provides a broad array of treatments for skin cancer and will be very honest and apply her extensive knowledge in recommending a treatment plan that is best for your unique situation.