MOHS-TEK began its roots within the medical community over 25 years ago. The company was founded by the late Girish Bhutani who had a vision for providing high quality mobile Mohs histotechnicians to physicians in the Southern California region. Since that time, MOHSTEK has expanded its mobile MOHS services and added an in-house Histology lab service to provide the medical community with the highest level of commitment imaginable. The original vision has also expanded to cover all of California (Northern, Central, and Southern) as well as Nevada, Arizona, Montana, and Texas. The company is now run by Girish’s wife, Seema Bhutani, and his nephew, Raj Bhutani.
Choosing the right company is important. MOHS-TEK can provide you with the highest level of Mohs techs the medical industry has to offer.
Developed by Frederic E. Mohs, M.D. in the 1930s, the Mohs Micrographic Surgical procedure has been refined and perfected for more than half a century. Initially, Dr. Mohs removed tumors with a chemosurgical technique. Thin layers of tissue were excised and frozen before being pathologically examined. He developed a unique technique of color-coding excised specimens and created a mapping process to accurately identify the location of remaining cancerous cells.
As the process evolved, surgeons refined the technique and now excise the tumor, remove layers of tissue and examine the fresh tissue immediately. The chemosurgical technique developed by Dr. Mohs is no longer used. This reduces the normal treatment time to one visit and allows for immediate reconstruction of the wound. The heart of the procedure-the color-coded mapping of excised specimens and their thorough microscopic examination-remains the definitive part of the Mohs Micrographic Surgical procedure.
Mohs Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas, but can be used to treat less common tumors including melanoma. Mohs Surgery is indicated when:
- The cancer was treated previously and recurred
- Scar tissue exists in the area of the cancer
- The cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips
- The cancer is large
- The edges of the cancer cannot be clearly defined
- The cancer grows rapidly or uncontrollably
The Mohs process includes a specific sequence of surgery and pathological investigation. Mohs surgeons examine the removed tissue for evidence of extended cancer roots. Once the visible tumor is removed, Mohs surgeons trace the paths of the tumor using two key tools:
- A map of the surgical site
- A microscope
Once the obvious tumor is removed, the Mohs surgeon:
- Removes an additional, thin layer of tissue from the tumor site
- Creates a “map” or drawing of the removed tissue to be used as a guide to the precise location of any remaining cancer cells Microscopically examines the removed tissue thoroughly to check for evidence of remaining cancer cells
If any of the sections contain cancer cells, the Mohs surgeon:
- Returns to the specific area of the tumor site as indicated by the map
- Removes another thin layer of tissue only from the specific area within each section where cancer cells were detected
- Microscopically examines the newly removed tissue for additional cancer cells
If microscopic analysis still shows evidence of disease, the process continues layer-by-layer until the cancer is completely gone.
Besides its high cure rate, Mohs Micrographic Surgery also has shown to be cost effective. In a study of costs of various types of skin cancer removal, the Mohs process was found to be comparable when compared to the cost of other procedures, such as electrodesiccation and curettage, cryosurgery, excision or radiation therapy. Mohs Micrographic Surgery preserves the maximum amount of normal skin and results smaller scars. Repairs are more often simple and involve fewer complicated reconstructive procedures.
With its high cure rate, Mohs Surgery minimizes the risk of recurrence and eliminates the costs of larger, more serious surgery for recurrent cancers. Because the Mohs procedure is performed in the surgeon’s office and pathological examinations are immediately, the entire process can often be completed in a single day.
The Mohs Surgeon
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery.
Early Events in the Development of the Mohs Technique
The Mohs surgical technique was developed in the 1930’s by Dr. Frederic Mohs, a general surgeon at the University of Wisconsin. This important development occurred while he was studying various injectable irritants to evaluate the in vivo inflammatory response in transplantable rat cancers and normal tissue. In the course of this study, Dr. Mohs noted that injected 20% zinc chloride solution inadvertently caused tissue necrosis in tumor and normal tissue. Further, he found that microscopic examination of this necrotic tissue showed well-preserved tumor and cell histology, the same as if the tissue had been excised and immersed in a fixative solution. This discovery formed the basis for a method by which cancers could be excised under complete microscopic control. This fixed tissue technique was utilized for over a decade, with Dr. Mohs being its pioneer, advocate, and lone practitioner. Long-term follow-up of his patients was carefully documented and gave further testimony to the effectiveness of this treatment. In 1953 a revolutionary breakthrough occurred while filming the removal of an eyelid carcinoma for educational purposes. An involved margin in the first level caused a delay in filming, this development necessitating utilization of horizontal frozen sections for the second and third levels. This fresh tissue technique worked so well that Dr. Mohs continued to use it for most eyelid cancers. He also found the technique useful for small and medium sized cancers at other sites, and subsequently continued to use the fresh tissue technique for multiple other skin cancers.
In 1969 Dr. Mohs reported the use of the fresh tissue technique for sixty-six basal cell carcinomas and for squamous cell carcinomas of the eyelid, with five-year cure rates of 100%. A corroborating series of data was instrumental in convincing the medical community of the validity of the fresh tissue technique, which had not yet largely replaced the fixed tissue technique. It is now well-established that the five-year cure rates using fresh tissue technique are equivalent to that of the fixed tissue technique. The fixed tissue technique is still recommended by some Mohs surgeons, however, for selected tumors.
Mohs Surgery’s Evolution as a Dermatologic Procedure
Dermatologists naturally gravitated to the Mohs technique and came to dominate the field, largely due to their training and expertise in skin cancer pathophysiology, cutaneous histopathophysiology, dermatologic surgery, and repair of complex defects. From the 1950’s to the 1970’s, Mohs surgical training was conducted on an informal basis. Training sessions lasted from several days to several months, and took place both in Dr. Mohs’ Chemosurgery Clinic and in the offices of physicians who had learned the technique firsthand from Dr. Mohs.