Mohs Surgery for the Treatment of Skin Cancer
In the late 1930s, Dr. Frederic E. Mohs developed a new concept in the treatment of skin cancer. This method of skin cancer removal has certain advantages: 1. Mohs surgery produces the highest cure rate for cancer. 2. Mohs surgery can achieve preservation of the maximum amount of healthy skin. 3. Mohs surgery is the most cosmetically elegant way to remove skin cancer because there is no guess work about where the cancer starts or stops.
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What is Mohs Surgery?
The concept behind this microscopically controlled surgical excision is that the surgeon also acts as the pathologist. The surgery is done in an outpatient setting under local anesthesia (local numbing medicine). Dr. Kramer often uses an instrument called a curette (a circular knife) in order to debulk the tumor. A scalpel is then used to excise the tumor with a minimal amount of skin being removed. Any bleeding is stopped and the specimen is taken to a Mohs laboratory station located in the office, where it is prepared for microscopic examination within 45 minutes. The technician preparing the specimen must be specially trained. Unlike the standard method, where the tumor tissue is cut vertically, the Mohs specimen is prepared in a horizontal fashion, providing multiple bird’s-eye views of the cancerous tissue. When the microscopic slides are ready, then Dr. Kramer acts as a pathologist and reads them. If the slides show complete removal of the tumor, then the patient is ready for closure. If, however, the microscopic examination shows that cancerous tissue is still present in the skin (i.e., its borders have not been removed), the exact location of the remaining tumor on the skin can be precisely mapped out for removal. This is possible because, just following tumor removal, dyes are used on various surfaces of the tissue in order to locate the exact position. By using this method, the cancerous tissue can be completely excised in one procedure, achieving not only the best chance of cure but also removal of the least amount of normal skin.
Closing the Wound
When Mohs surgery has been performed and all the cancer has been removed, a wound or defect results. The defect can be repaired in different ways. Sometimes, the Mohs surgeon will allow the wound to heal on its own. This is known as secondary intention. In other cases, Dr Kramer will suture, or stitch, the area closed, either sewing one side to the other or, if needed, doing a skin flap. A skin flap involves making an extra incision or incisions into the skin in order to help move adjacent skin to close the defect. In some cases, Dr Kramer will use a skin graft to repair the wound. A skin graft essentially is a patch of skin that is taken from another location, such as the back of the ear or front of the ear, and then placed where it is needed, such as the tip of the nose.
Who Can Benefit?
Mohs surgery is often performed for basal cell carcinoma and for the second most common type of skin cancer, squamous cell carcinoma. Mohs surgery has a 99% cure rate for basal cell carcinomas that have not previously been treated.
How Long Does It Take?
The average case lasts two to four hours. Most of the time is spent waiting in the waiting room while we prepare and examine the tissue. Eat a good breakfast; bring reading material or something to occupy your time.