Take Charge of Your Health - Moh's Surgery
The good news for you is that all of this can be avoided by being diligent with your sun protection. I got serious a bit late but now I am slathering on SPF 30, reapplying as needed, wearing long sleeves, and a wide brim hat and doing regular total body checkups...
that is a MUST!
- Christie Brinkley, successfully treated for basal cell carcinoma
Skin cancer is the most common form of cancer in the United States, with over 1 million new cases every year. (One in three reported cancers is a skin cancer.) Eighty percent of the time, skin cancer is on the face, head, or neck and most commonly caused by ultraviolet radiation from the sun. Mohs surgery, (also known as Mohs micrographic surgery), is a very precise, effective surgical technique and often used to treat two of the most common types of skin cancer -- basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCC is the most common type of skin cancer; it typically grows slowly and rarely spreads. SCC is more aggressive and may spread. Mohs surgery is also sometimes used for less common skin cancers such as certain melanomas -- especially if they are early-stage or in sensitive areas.
Mohs surgery is minimally invasive and particularly well-suited for cancers on the face, ears, hands, and feet. Traditional skin cancer treatment most often involves excising the lesion and a reasonable margin and sending that specimen out to lab for a pathology evaluation. With the conventional procedure, about 5% of the margins are evaluated in the lab. If there are cancer cells at the margins, the patient is called, (typically within a week or so) and asked to return to the clinic, where the surgeon does a wider excision and this new specimen is then sent back to the lab and the pathologist for additional examination. The process is repeated until the margins are free of cancer cells. The process can be quite burdensome with multiple trips to the physician, multiple procedures performed, wait times to get the pathology results, and greater stress for the patient.
With Mohs surgery, the procedure is much more efficient and assesses 100% of the margins. Mohs surgery removes thin layers of skin, one at a time, and immediately examines each layer under a microscope in a lab within the facility. The process continues until all cancerous cells are eliminated. The procedure can take place in a surgery center or a surgeon’s office as long as the lab is right there. Since the surgeon looks at all of the tissue’s edges before ending the procedure, Mohs has a much higher cure rate than standard surgery.
The steps with Mohs surgery are as follows:
The area around the skin cancer is numbed with a local anesthetic.
The surgeon removes a thin layer of tissue that includes the visible cancer and a margin of healthy tissue.
The removed tissue is examined in a lab located onsite/near the procedure room where they immediately freeze, cut, and stain the tissue.
The microscopic examination allows for precise identification of cancerous cells and helps ensure complete removal of the tumor.
If cancer cells are found at the edge of the removed tissue, another thin layer of tissue is removed from that specific area.
The surgeon makes a map to keep track of the exact spot where each piece of tissue is removed, so if a small area of cancer is found, the surgeon knows exactly where to continue. (The surgeon can inject more local anesthesia as needed for patient comfort.)
The process is repeated until no cancer cells are detected. The average length of surgery is about 3 hours and the patient leaves the facility cancer-free.
Depending on the size and location of the wound, it may heal on its own, be closed with stitches, or require reconstructive surgery.
Patients may be asked to wear a bandage over the wound for a week or longer and the surgeon will provide instructions on how to care for the wound. It is important to keep the wound area out of the sun.
There are many advantages to the Mohs surgical procedure. By ensuring complete cancer removal, it provides the highest cure rate, particularly for basal cell and squamous cell
carcinomas -- up to 99% for skin cancer that has not been treated before and up to 97% for skin cancer that has recurred after previous treatment. Mohs surgery is very precise and by minimizing the removal of healthy tissue, there are smaller scars and better cosmetic outcomes. This is especially beneficial in sensitive areas like the face. And since the procedure is started and finished the same day it is much more convenient and patient-friendly.
Mohs surgery is considered the most effective procedure for treating basal cell carcinomas and squamous cell carcinomas. According to the American Society for Mohs
Surgery, approximately 850,000 Mohs surgeries are performed in the US annually. It is always wise to visit a dermatologist regularly to be sure your skin (which is the largest organ in our bodies) is free from these problematic and treatable cancers.