No one wants to hear the dreaded “C” word whether it’s at their general practitioner’s office or the dermatologist’s practice. If you do receive a skin cancer diagnosis, you may immediately feel scared and overwhelmed, but the good news is that there is a safe and effective treatment option. According to Dr. Kristyna Gleghorn of U.S. Dermatology Partners in Cushing, Oklahoma, “Mohs micrographic surgery is a tissue-conserving method of removing skin cancer with a high cure rate. The Mohs surgeon is also the pathologist and is able to map out exactly where the skin cancer is, so that less normal tissue has to be removed. It is one of our most effective treatment options for skin cancer, especially on the head, neck, and other high-risk locations where preserving normal tissue is important. It’s important to complete regular skin self-exams and visit a dermatologist regularly to help find skin cancer in the earliest and most treatable stages.” In this blog, Dr. Gleghorn will discuss the top five reasons dermatologists recommend Mohs surgery for skin cancer treatment.
What Skin Cancers Should be treated with Mohs surgery?
Mohs surgery is a surgical treatment for skin cancers commonly recommended for basal cell carcinoma and squamous cell carcinoma, the two most common types of skin cancer, when located on the head and neck and other high-risk areas including the hands, feet, ankles, nails, and genitalia. It is sometimes used for skin cancers on other parts of the body, especially if the skin cancer is large, an aggressive type, recurrent to a prior treatment, or if you have an immunosuppressive condition. It may also be recommended for melanoma, Merkel cell carcinoma, and other less common skin cancers in certain situations. Your physician will be able to let you know if your skin cancer should be treated by Mohs surgery or another treatment modality.
What Is Mohs Surgery?
Mohs surgery is an office-based surgical procedure used to treat certain skin cancers. To begin, the Mohs surgeon carefully identifies the site of the skin cancer. Then, the area is numbed using an injection of a local anesthetic. Once the treatment area has been numbed, the skin cancer and a thin layer of surrounding skin are removed. The surgeon takes the layer of skin to the lab where it is inked and processed onto slides for the surgeon to read. While the tissue is being processed in the lab, you will be bandaged and wait for the results. This part usually takes 45 minutes to an hour, depending on the size of your cancer. If the slides show more cancer, the surgeon will map out exactly where the cancer is growing and take more tissue in that specific area. The Mohs surgeon removes another layer of tissue until no additional cancer cells remain.
After the skin cancer is removed, your surgeon will discuss repair options with you. Mohs surgeons are trained in advanced reconstruction techniques and the type of repair recommended will depend on the size and location of your cancer, as well as your preference. Oftentimes, the two edges of the wound are brought back together in a straight line with stitches. Sometimes the wounds are left to heal on their own with natural healing. If bringing the two edges together creates a lot of tension but a closure is still desired for faster healing, Mohs surgeons are trained to perform skin grafts or local flaps as well.
Top five reasons dermatologists recommend Mohs surgery for skin cancer treatment:
1 – It’s the Most Conservative Treatment Option
The main goal of skin cancer treatment is to ensure that all of the cancer cells are removed. In a traditional surgical excision, the skin cancer and a standardized margin of normal tissue surrounding the cancer cells are removed. Mohs surgery is tissue-sparing because checking the borders allows the surgeon to take less normal skin around the cancer. According to Dr. Gleghorn “The Mohs procedure includes removal of the skin cancer and immediate microscopic examination of the surgical margins. A precise mapping technique allows the physician to identify the exact location of any remaining cancer cells so that further removal can be done in that area, but areas of normal skin do not have to be removed with subsequent stages. The procedure is repeated until the cancer is removed completely.”
2 – The Most Complete Skin Cancer Removal
In addition to preserving healthy skin, Mohs surgery has one of the highest cure rates and lowest recurrence rates among treatment options for skin cancers. The procedure involves removing one layer of tissue at a time. Then, the tissue is processed onto slides and the surgeon examines the removed layer carefully under a microscope. If there is cancer seen, more tissue will be taken in that specific area until the cancer is completely removed. Because the Mohs surgeon is both the person performing the removal of the skin cancer and the pathologist, Mohs surgery is as much as 99% effective at completely removing skin cancer. According to Dr. Gleghorn, “Mohs surgery offers patients the highest available cure rate for skin cancer while preserving as much of the normal tissue as possible.”
3 – Same Day Pathologic Confirmation
Another benefit of Mohs surgery is that the microscopic borders are checked immediately on-site. When the Mohs surgery is complete, you will have pathologic confirmation that the cancer is completely removed prior to the surgeon putting in any stitches for the repair. In comparison, when a traditional excision is performed, it takes a few days to a week to get the pathology report back stating if the cancer was completely removed or not. Since most dermatologists and Mohs surgeons repair the defect with stitches on the same day as a traditional excision, a positive margin means that the entire scar from the first procedure may have to be excised resulting in a much larger defect.
4 – Minimized Risk of Scarring
Another benefit of the conservative nature of Mohs surgery is the cosmetic result. Dr. Gleghorn says, “Completely removing cancer cells is the first priority of any cancer treatment, but your dermatologist also wants to ensure your skin heals well and looks healthy again after the procedure. Mohs surgeons are trained in advanced reconstruction techniques to minimize the appearance of scars. Because we check the borders immediately, we are able to keep the defects as small as possible resulting in a smaller defect and smaller repair.”
5– No Need for Hospitalization & General Anesthesia
Mohs surgery is an office-based procedure that usually involves local anesthesia to numb the area instead of general anesthesia. Avoiding hospitalization and general anesthesia saves time, money, and it is much safer.
The Importance of Skin Exams
The key to successful skin cancer treatment, according to Dr. Gleghorn is, “Early diagnosis and treatment. The most common skin cancers (basal cell carcinoma and squamous cell carcinoma) rarely spread to other parts of the body unless they are left for a long period of time.” In order to diagnose skin cancer in the earliest stages, it’s essential to perform skin self-exams once a month and visit a dermatologist at least once each year for a professional skin cancer exam. During self-exams, you should carefully look at all areas of skin from the top of the head to the bottoms of the feet. Note any new marks or changes to old spots and moles. Specifically, you should be scanning for the ABCDEs of skin cancer:
- A – Asymmetry – one half is unlike the other half
- B – Border – an irregular, scalloped, or poorly defined border
- C – Color – varied shades of tan, brown or black, or sometimes multiple colors (white, red, blue, brown, black)
- D – Diameter – spots that are larger than the diameter of a pencil eraser (6 mm)
- E – Evolution – spots that are changing in size, shape, or color
If you notice any of these changes, it’s important to contact your dermatologist to have the areas checked.
How Do I Get Started?
Whether you’ve recently been diagnosed with skin cancer, notice a concerning new spot, or just want to have your skin looked over, don’t hesitate to reach out to U.S. Dermatology Partners for a skin check. Our dermatologists and Mohs surgeons have advanced training and experience in diagnosing skin cancer and providing personalized treatment plans. When you’re ready to schedule with one of our local dermatology offices, we invite you to take a few moments to complete our online scheduling request form. Once we receive your scheduling request, a dermatology team member will be in touch to finalize the details of your upcoming appointment.
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