History of Mohs Surgery
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.
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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 tumours.
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