What Is Mohs Surgery? A Dermatology Surgeon Describes Jill Biden’s Skin Cancer Procedure

Jill Biden has undergone Mohs surgery to remove a small lesion her doctor discovered during a routine skin cancer examination. What is Mohs surgery, and what does it suggest about the First Lady's health?

Today, Jill Biden underwent Mohs micrographic surgery, commonly known as Mohs surgery, to remove a small lesion above her right eye that was found during a routine skin cancer examination. President Biden accompanied the First Lady to Walter Reed National Military Medical Center, according to media reports.

What is Mohs surgery, and what does the procedure suggest about First Lady Jill Biden’s health? Reports have not confirmed that Dr. Biden has skin cancer. The New York Times has quoted Dr. Kevin C. O’Connor, who said Dr. Biden’s Mohs surgery was being performed “in an abundance of caution.” (The Times reports Dr. O’Connor is the Bidens’ longtime personal care physician who now serves as the White House physician.)

Mohs surgeon Brett Coldiron, MD, FACP, FAAD, a clinical associate professor at the University of Cincinnati and founder of the Skin Cancer Center of Cincinnati, spoke with The Healthy @Reader’s Digest to explain what Mohs surgery means. Dr. Coldiron says he performs close to 1,000 Mohs surgeries a year.

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What is Mohs surgery?

During Mohs surgery, a skin cancer surgeon removes the tumor and a thin layer of tissue surrounding it to look for cancer cells under a microscope. Another layer is removed if cancer cells are found and sent to the lab for inspection. This process continues until there are zero cancer cells. “You keep as much healthy skin as possible,” Dr. Coldiron says.

He adds that this is especially important when skin cancer develops near the eye, which is a delicate area. In fact, says Dendy Engelman, MD, a New York City-based cosmetic dermatologist and Mohs surgeon at Shafer Clinic, Mohs surgery “is preferred” around the eye “because it gives the highest cure rate while preserving the most amount of tissue.”

According to the American Academy of Dermatology, the area around the eyes is especially vulnerable to damage from the sun’s ultraviolet rays, making it a common, though rarely mentioned, spot for skin cancer to develop. (Read 4 Surprising Spots That Are Musts for Sunscreen, Says Research)

The Mohs procedure is performed under local anesthesia, Dr. Coldiron says. The pathology examination of the skin sample is done in stages while the patient waits. “We check the edges in the lab until we get 100% of the margin,” Dr. Coldiron says. Each lab review can last about an hour.

There is typically some pain after the procedure, which Dr. Coldiron says most patients can manage with over-the-counter painkillers. The advantage of Mohs surgery is often worth it, he says: “It costs less than conventional skin cancer surgery, has a higher cure rate, and you don’t get put to sleep.”

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“Is the Mohs procedure right for me?”

Not everyone with skin cancer is a Mohs surgery candidate, Dr. Coldiron explains. The cure rate of Mohs surgery “is 99% for basal cell carcinoma and 95-plus percent for squamous cell carcinoma, which is about eight or nine percent higher than conventional skin cancer surgery,” he says.

Mohs surgery is indicated for melanoma—the potentially terminal form of skin cancer—only when the cancer has not yet started to spread. On occasion, Mohs surgery can be used for invasive melanomas on the face where there is less tissue to spare, and when achieving a cosmetically appealing result matters, he says.

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Sources
Brett Coldiron, MD, clinical associate professor, University of Cincinnati, founder, Skin Cancer Center of Cincinnati, Ohio   Dendy Engelman, MD, cosmetic dermatologist, Mohs surgeon, Shafer Clinic, New York City.   AAD. What is Mohs surgery? https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery

Denise Mann, MS
Denise Mann is a freelance health writer whose articles regularly appear in WebMD, HealthDay, and other consumer health portals. She has received numerous awards, including the Arthritis Foundation's Northeast Region Prize for Online Journalism; the Excellence in Women's Health Research Journalism Award; the Journalistic Achievement Award from the American Society for Aesthetic Plastic Surgery; National Newsmaker of the Year by the Community Anti-Drug Coalitions of America; the Gold Award for Best Service Journalism from the Magazine Association of the Southeast; a Bronze Award from The American Society of Healthcare Publication Editors (for a cover story she wrote in Plastic Surgery Practice magazine); and an honorable mention in the International Osteoporosis Foundation Journalism Awards. She was part of the writing team awarded a 2008 Sigma Delta Chi award for her part in a WebMD series on autism. Her first foray into health reporting was with the Medical Tribune News Service, where her articles appeared regularly in such newspapers as the Detroit Free Press, Chicago Sun-Times, Dallas Morning News, and Los Angeles Daily News. Mann received a graduate degree from the Medill School of Journalism at Northwestern University in Evanston, Ill., and her undergraduate degree from Lehigh University in Bethlehem, Pa. She lives in New York with her husband David; sons Teddy and Evan; and their miniature schnauzer, Perri Winkle Blu.