What Is Mohs Surgery? Jill Biden Has 2 Cancerous Lesions Removed During Procedure

First lady Jill Biden had two cancerous lesions removed Wednesday during an outpatient procedure known as Mohs surgery, according to a memo released by her press secretary.

The first lesion was removed from the skin above her right eye; another was removed from the left side of her chest. All cancerous tissue was removed, and the first lady's margins were clear of any residual cancer cells, the medical memo said.

Both lesions were confirmed to be basal cell carcinoma (BCC), a type of slow-growing and typically curable cancer. BCC is the most common type of skin cancer; in the U.S., there are approximately 3.6 million cases diagnosed each year.

Kevin O'Connor, DO, physician to the president, confirmed last week that the first lady would be undergoing Mohs surgery. He added that the surgery is "a common outpatient procedure" and was being done "in an abundance of caution."

According to Wednesday's medical memo, Biden is "experiencing some facial swelling and bruising, but is in good spirits and feeling well."

What Is Mohs Surgery?

Mohs surgery is a technique used to treat certain types of skin cancer, and is the most effective treatment for many basal cell carcinomas and squamous cell carcinomas.

The surgery is named after physician Frederic Mohs, who first published articles about his technique in the 1940s, according to Ida Orengo, MD, chair of dermatology at the Baylor College of Medicine. After being advanced in the 1970s, the procedure has now become standard for any skin cancer in the head and neck region.

“Our [claim to fame] is that we have the best cure rate—up to 99% on a primary lesion, which means one that’s not been treated before,” Dr. Orengo told Health. The cure rate is up to 94% for skin cancer that has recurred.

Mohs surgery is an outpatient procedure, meaning a patient receives a local anesthetic, remains awake during the procedure, and can leave the hospital or medical office soon after.

The surgery is done in stages: a Mohs-trained dermatologist removes a lesion layer-by-layer, checking for cancer cells in the skin tissue every step of the way. The procedure aims to remove unhealthy tissue while sparing healthy tissue—the process is done when cancer cells are no longer detectable.

"The process is repeated until you reach a point where the cancer is completely out," Ariel Ostad, MD, Mohs surgeon, associate clinical professor at NYU Langone Medical Center, and Skin Cancer Foundation spokesperson, told Health. "It can take from one stage to sometimes multiple stages, depending on how late the cancer is diagnosed—typically most cancers are removed in one to two stages."

Once the cancer is completely gone, the dermatologist will close the small wound with stitches, or a skin graft or flap, said Dr. Orengo.

Despite its complexity, the Mohs surgery is the “standard of care” for anyone who has a suspicious lesion that turns out to be a form of skin cancer, according to Dr. Ostad. The care Biden’s doctors have recommended is the same as what any patient in this situation would likely get.

In addition to its extremely high success rate, other factors also make Mohs surgery the go-to procedure for certain skin cancers.

The procedure is cost-effective. Mohs surgery is usually performed by a dermatologist who’s completed an Accreditation Council for Graduate Medical Education (ACGME) fellowship. With this extra training, doctors not only learn how to perform the surgery correctly, but also learn the skills of other types of doctors—this makes things more inexpensive.

“The surgery is done under local anesthesia, so we act as the anesthesiologist. We act as the surgeon removing the tumor. We also read our own slides, so we're also doing the pathology interpretation. And then we also do the reconstruction,” said Dr. Orengo. “Basically it's like one-stop shopping—you get everything done by one doctor, and so there’s not a lot of extra fees.”

Healing After Mohs Surgery

Because Mohs surgery allows doctors to remove lesions slowly and in layers, it results in few cosmetic issues, Dr. Ostad added.

“Initially, the scar is a bit noticeable," said Dr. Ostad. "It's a fine line, which over the course of three months to a year just really fades considerably and it's barely noticeable.”

Like the procedure itself, the recovery after Mohs surgery is also standard: patients can expect to stay home and rest for a couple of days after their surgery, and would likely see some mild swelling, bruising, or bleeding, said Drs. Ostad and Orengo.

Though there’s always the possibility that any surgery can lead to an infection, there are no specific complications from Mohs surgery. For the best outcome, patients are instructed to carefully follow their doctor's instructions for wound and scar care.

Following Mohs surgery, patients are also instructed to continue routine dermatology checkups to make sure the skin cancer doesn't return.

“When somebody has, unfortunately, a skin cancer, no matter how it's treated, the risk of getting a second skin cancer is about 50% in five years,” said Dr. Ostad. “So [people] need long term skin cancer screenings, just to make sure [they don't] get anything new. And also to make sure that that area doesn't come back.”

Skin Cancer Screenings Matter

Biden's surgery should be a reminder to everyone to keep an eye on their skin and undergo screenings when necessary, so suspicious lesions can be caught early, diagnosed, and treated, said Drs. Orengo and Ostad.

“A lot of times, skin cancers, when they’re extremely early, they look like nothing, they look like a little pimple,” said Dr. Ostad. “So people who may not have access to healthcare may think, ‘Oh, this is nothing, I'm just going to wait.’ And then all of a sudden they see like six months later it's still there. It's bigger.”

The U.S. Preventive Services Task Force (USPSTF) has said there's not enough evidence to recommend for or against routine skin cancer screenings for people at average risk (no history of skin cancer and no suspicious moles or spots), but if any new or unusual moles or skin changes should be discussed with a healthcare provider.

“The key is early detection,” said Dr. Ostad. “Early detection leads to a cure, leads to less scarring, less deformity, better cosmetic outcomes.”