Last week, I underwent Mohs surgery to treat basal cell carcinoma on my face. The surgery was successful and I am fine. If you aren’t familiar with the surgery, it involves cutting away thin layers of skin. Each thin layer is looked at closely for signs of cancer. The process keeps going until there are no signs of cancer. It is estimated that the procedure has been performed approximately 25 million times since its invention.
The procedure is incredibly effective with a cure rate of up to 99%. It is also a great deal in that it costs about $2500 per lesion to perform the Mohs surgery. In contrast, an average cancer treatment that includes chemotherapy and radiation can cost up to $250,000.
As I was going through the surgery, I was thinking about all of the research that went in to developing the process and how much of that research was federally funded. Here’s a review of the key technologies involved in the Mohs procedure.
Key Technologies Used in Mohs Surgery
1. Zinc Chloride Paste ("Mohs Paste")
Inventor: Dr. Frederic E. Mohs (University of Wisconsin), 1930s
Purpose: Fixes tissue in place to preserve tumor and normal cell histology for microscopic control.
Funding: Mohs' early work was academic; many initial experiments conducted in university labs (e.g., UW). While specific grants aren't cited, historians note it was part of institutional research programs, likely supported by public university funding.
2. Fresh-Tissue Frozen Section Technique
Pioneers: Dr. Mohs and later Dr. Perry Robins (NYU), mid-1960s
Advancement: Shifted from paste fixation to fresh tissue frozen sectioning (cryostat), enabling same-day surgery and reconstruction.
Funding: Developed in clinical and academic settings; likely funded through national health institutes and university grants for pathology innovation.
3. Cryostat Microtome
Commercial Developers: Early pathology equipment companies developing cryostats in 1960s–70s
Function: Freezes tissue slices for microscopic margin analysis to guide precise excision.
Funding: Research labs and hospitals purchased early prototypes; improvements were typically funded by NIH equipment grants and industry R&D.
4. Frozen Section Microscopy & Tissue Mapping
Concept Developers: Dr. Daniel Jones coined “micrographic surgery”; Perry Robins formalized mapping
Purpose: Detailed tissue mapping ensures complete margins and preservation of healthy tissue.
Funding: Likely supported through academic and government research grants in pathology and surgical oncology — though specifics aren't public.
5. Histological Staining (H&E, Immunohistochemistry)
Methodology: Hematoxylin and eosin staining standard by mid-20th century; immunostains (e.g. MART-1, HMB‑45) later advanced by dermatopathologists like Dr. June K. Robinson
Function: Enables accurate visualization of tumor cells, including in melanoma.
Funding: Immunohistochemistry techniques typically emerged from NIH-funded pathology research.
6. Advanced Stains for Melanoma Margins
Key Innovators: Dr. June K. Robinson (1990s)
Purpose: HMB‑45 and anti-keratin staining improve detection in frozen sections, expanding Mohs utility.
Funding: Likely supported by NIH dermatology grants, though direct sources aren't public.
The point of all this is simple: many of our most effective medical breakthroughs—like Mohs surgery—exist because government chose to invest in science. From frozen section microscopy to immunostaining, nearly every element of the procedure has roots in publicly funded research. These weren’t corporate moonshots. They were quiet, sustained investments in knowledge.
And yet, in the latest budget bill, the Trump administration has proposed slashing the NIH budget by 40%, eliminating entire institutes, and gutting the very agencies that ensure drug safety and scientific progress. The FDA is bracing for mass layoffs. Other research engines face cuts of up to 55%.
We tell ourselves these are savings. But when you cut research, you’re not saving—you’re delaying the next cure. You’re raising the price of treatment down the line. And in some cases, you’re trading lives for line items.
We say we don’t want to pay for science. But one way or another, we will pay—for longer illnesses, more expensive treatments, and missed opportunities.
So no, we’re not just cutting off our nose to spite our face.
We’re doing it with precision.
And we’re doing it without anesthesia.
Lets see... 25 million * 250,000 = 6.25 trillion dollars saved....