Mohs Surgery
Mohs Surgery
Every year more people are diagnosed with skin cancer than all other cancers combined. Skin cancer commonly occurs on sun-exposed skin. Those at highest risk are fair-skinned individuals and those who spend a significant time in the sun for work or outdoor activities. Better prognoses result from early skin cancer diagnosis and treatment.
FAQs
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There are two main categories of the most common types of skin cancer: melanoma and nonmelanoma skin cancers (NMSC). There are two types of NMSCs: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Approximately 80% of skin cancers are BCC,16% are SCC, and 4% are melanomas. At least one in five Americans will develop skin cancer by age 70.
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90% of nonmelanoma skin cancer, and 86% of melanomas are associated with UV radiation.
More people develop skin cancer from indoor tanning than lung cancer from smoking.
Indoor tanning is responsible for about 6200 cases of melanoma.
5 or more sunburns double the risk for developing melanoma.
Just one blistering sunburn in childhood or adolescence more than doubles the lifetime risk of developing melanoma.
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Board certified dermatologists are formally trained to identify skin lesions that are highly suspicious for skin cancer. They are also trained to use various devices to aid in the diagnosis of skin cancer, such as, using an instrument called a dermatoscope. A dermatoscope allows the dermatologist to see features of the skin lesion that are not viewable with the naked eye, such as, blood vessels and various colors. When the dermatologist suspects skin cancer, the physician will take a biopsy. The biopsy is reviewed by a board certified dermatopathologist to determine the type and staging of skin cancer.
Surgical Options for Skin Cancer
Squamous cell carcinoma (SCC)SCC is also caused by years of sun exposure that most commonly affects light-skinned individuals. It can appear anywhere, including the mouth, lips, and genitals. SCC most commonly presents on sun-exposed skin. SCC appears as firm, red bumps, scaly patches, or a sore that won’t heal. SCC has the potential to spread to other parts of the body and be fatal. When caught early, SCC can be cured. Surgery or Mohs surgery is the treatment of choice, but may include topical chemotherapy drugs, and at times, radiation therapy may be recommended.
Certain types of skin cancer grow slowly and spread locally, while others grow quickly and spread to lymph nodes and other organs. In every case, it is essential that all cancer cells be removed. Treatment options vary based on the type of skin cancer, the size, location, and depth of the tumor, as well as age and health of the patient. The majority of skin cancer treatments can be performed in the office or an outpatient facility under local anesthesia.
MelanomaThe deadliest form of skin cancer is malignant melanoma. It is a result of the overgrowth and mutation of skin cells called melanocytes. Melanocytes produce melanin, which gives color to skin. It is malignant and invades deep into the skin, other vital structures, and spreads to other parts of the body. Because there are melanocytes in all skin and other vital organs, melanoma can be found in the eyes and also under the finger and toenails. 7% of new cancer cases in men, and 5% of new cancer cases in women are melanomas. Men are more likely to develop melanoma on the chest and back, while women are more likely to develop melanoma on the legs. The majority of people who develop melanoma are white men over the age of 55. However, all individuals including skin of color can develop melanoma. Furthermore, only 20-30% of melanomas are found in existing moles. Melanoma most commonly occurs as a new skin spot.
Basal cell carcinoma (BCC)BCC is a slow-growing skin cancer that almost never spreads to other parts of the body. However, BCC continues to grow and invade and destroy local tissue. Those at risk are fair-skinned individuals with significant amounts of sun exposure. BCC most commonly develops on the face, nose, chest, neck and back of the hands. BCC appear as small, shiny bumps that slowly enlarge. They can break open, bleed and form a scab or look like a scar. Early diagnosis and treatment can reduce the risk that BCC can grow deep and destroy tissue and bone. Mohs surgery is often recommended to spare healthy tissues and prevent disfigurement.
Surgical options for skin cancer
Mohs SurgeryLocalized treatments are generally reserved for low-risk superficial tumors and include: cryosurgery, topical therapy, photodynamic therapy (PDT), and electrosurgery
Wide local excision involves cutting out the tumor along with extra margins of normal skin. If wide margin excision can cause disfigurement or loss of anatomical function, Mohs micrographic surgery will be recommended.
Mohs micrographic surgery (Mohs or Mohs surgery) involves removing the tumor in stages or layers. Each layer is mapped and examined under a microscope to check for cancer cells. The procedure is repeated until no more cancer cells are seen. While Mohs surgery can take hours, the result is the preservation of as much healthy skin as possible and a hidden scar. Mohs surgery requires specialized training. It is recommended when wide local excision can cause disfiguration, when tumors are on certain locations such as, the face, eyes, lips, nose, and genitals, and when it is difficult to determine the extent of the cancer.
The Procedure
During the Mohs surgery, patients are awake and alert as it is performed under local anesthesia. It is performed safely and comfortably in our medical office. On the day of surgery, each patient is prepped for the procedure after an in-depth discussion of what the day will entail, including wound care instructions and post-operative considerations.
Prior to the surgery, an anesthetic is injected to minimize pain during the procedure. The skin cancer is surgically removed via an intricate technique to provide tissue sparing while removing the visible tumor. While the surgical layer is being processed in the lab, a bandage is placed over the area during the waiting process. The Mohs surgeon looks at the removed skin cancer under the microscope, and if there are any remaining cancer cells, another layer of skin is prepped for removal. This process is repeated until there are no remaining cancer cells visualized.
Once the skin cancer is cured, the Mohs surgeon will repair the open area taking into consideration what will provide the best cosmetic outcome. The great team providing care during the procedure will ensure that all the wound care instructions are discussed in detail with scheduled follow up care for optimal outcomes and well-being.
Other Surgical TreatmentsMetastatic skin cancer can’t be treated with local therapy. Options include targeted therapy, chemotherapy, immunotherapy, and clinical trials.
- The primary skin cancer is surgically excised.
- Radiation and chemotherapy are adjuvant treatments used to kill remaining cancer cells after surgery or in other metastatic locations.
- Immunotherapy may be recommended to boost the patient’s immune system to fight the cancer.
- Drug therapy is targeted therapy to attack the cancer cells without causing harm to normal cells.
Basal cell carcinoma (BCC) treatments
When BCC is localized (has not metastasized/spread) treatment options include simple excision, Mohs micrographic surgery, radiation therapy, electrosurgery, photodynamic therapy, topical chemotherapy or immunotherapy. However, simple excision can cause significant scarring and possibly loss of function. Therefore, when BCC is found in a location where excision would cause disfigurement, Mohs surgery will be recommended to spare healthy tissue, reduce scarring, and preserve function.
Squamous cell carcinoma (SCC) treatments
Localized SCC can be treated with simple excision, Mohs, radiation therapy, and electrotherapy. SCC in situ in certain circumstances, may be treated with photodynamic therapy. When SCC spreads beyond the localized tumor, treatment options also include chemotherapy and immunotherapy.
Metastatic melanoma treatments
Melanoma in situ, which is confined to the most superficial layer of skin and has not spread, is treated with surgery.
Depending on the stage of melanoma, discussed in the Skin Cancer Types section, treatment may include surgical excision, lymph node removal, immunotherapy, chemotherapy, and/or radiation to kill any remaining cancer cells and lower the risk of recurrence.
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