Mohs Micrographic Surgery

Cancer is the growth of abnormal cells at an uncontrolled and unpredictable rate. As cancer cells grow, they destroy the surrounding normal tissue.
The most common types of skin cancer are:

• Basal cell carcinoma (300,000 to 400,000 new cases are diagnosed per year)

• Squamous cell carcinoma (80,000 to 100,000 new cases per year)

• Malignant melanoma (25,000 cases each year)

These cancers all originate in the skin, but, if left unattended, can invade and destroy muscle, bone and other structures. Metastasis, which is the spread of cancer beyond the site of the original growth or lesion, often follows untreated malignant melanoma and can be fatal. Squamous cell carcinoma can also metastasize.
Unlike other forms of cancer in internal body organs, skin cancer can be seen without the aid of sophisticated medical equipment. This way patients can identify the lesions and seek treatment in the early stages, while the cancer is still small and can be easily cured.
Prevention
Skin cancers are usually the result of damage to the skin cells by years of sun exposure. Premature aging of the skin may also be caused by too much sun. Some common sense precautions can prevent further damage:

• Avoid outdoor activities during peak sunlight hours—.10:00 AM to 2:00 PM.

• When in the sun, wear a hat and cover up as much as possible.

• Use a sunscreen with a Sun Protection Factor (SPF) of at least 15 on all exposed skin. Reapply frequently, particularly if swimming or perspiring. Don’t be fooled by cloudy or overcast days—the damaging radiation can still get through. People with light complexions who do not tan easily or those with a family history of skin cancer should be especially careful about excessive sun exposure.

• Beware of light-colored reflective surfaces such as sand, snow and water, which magnify the potential harm to skin. Use special caution when at high altitudes and near the equator, where the effect of the sun is stronger

• Avoid tanning booths and sun lamps. The ultraviolet (UV) light they emit is just as injurious as that of the sun.

The Signs of Skin Cancer
Skin cancer may arise in a number of ways. If you notice any of the following signs or symptoms, consult your doctor as soon as possible.

• A new growth on the skin of an adult that does not disappear in four to six weeks.

• Any skin lesion that grows larger and turns pearly, translucent, brown, black or multicolored.

• A mole, birthmark, or beauty mark that increases in size, changes color or texture or becomes irregular in outline.

• An open sore or wound that refuses to heal, persists for more than four weeks, or heals and later reopens.

• Any skin spot or growth that continues to itch, hurt, crust over, form a scab, erode, or bleed for several weeks.

The Importance of Biopsy
There are many benign skin growths or lesions that resemble skin cancer but that are obviously not cancer when seen under the microscope. In many cases, a biopsy is the only way to distinguish between a cancer and an innocent mole or wart.
TREATMENT
Time-honored techniques for the treatment of skin cancer include:

• Electrodessication—this involves scraping away the diseased tissue with a surgical instrument and then using an electrical unit to stop the bleeding.

• Surgical Removal

• Cryotherapy—liquid nitrogen is used to freeze the cancerous tissue. The freezing kills the cancerous tissue with a minimum of scarring.

• Mohs micrographic surgery — a comparatively recent form of skin cancer surgery that is becoming increasingly popular.

Your dermatologist will discuss with you the most appropriate method of treatment for your skin cancer
When is Mohs Micrographic Surgery Indicated?
Although the concept of Mohs micrographic surgery was developed more than 50 years ago, relatively few dermatologists were trained in its use until recently. Only in the last few years has the technique become widely available throughout the country.
Mohs micrographic surgery is now universally recognized as a precise method for treating skin cancers. It is especially effective in cancers of the face and other cosmetically sensitive areas, because it can eliminate virtually all the cancer cells while causing minimal damage to the surrounding normal skin.
Mohs micrographic surgery is also ideal for the removal of recurrent skin cancers—tumors that reappear after treatment and can plague a patient repeatedly While skin cancers are easily visible to the patient, individual cancer cellsare microscopic and anycells left behind can cause the tumor to reappear The tumor may spread beyond its obvious external margins, with "nests" of cells growing in unpredictable areas. With the Mohs technique, all tumor nests can be identified and removed with a high degree of accuracy, so that extremely high cure rates, as high as 95 per cent, are possible even when the cancer is recurrent.
A dermatologist is best trained to determine when this technique should be used rather than the other effective procedures also available for treating skin cancer
What is Mohs Micrographic Surgery?
Mohs micrographic surgery is named in honor of the physician who developed the basic technique, Dr. Frederic Mohs. You may hear it called Mohs surgery, chemosurgery, microscopically controlled surgery or histographic surgery—it’s all the same. In the years since Dr. Mohs pioneered the procedure, many technical improvements and refinements have contributed to make micrographic surgery a safe and highly effective means of treating skin malignancies.
The main difference between micrographic surgery and other methods of removing skin lesions is microscopic control. In Mohs surgery multiple thin, horizontal layers of the cancer are removed. The surgical removal proceeds along a grid pattern, with each layer carefully identified and "mapped" by the surgeon so that its exact location can be pinpointed on the wound.
Every layer of tissue removed is inspected under the microscope for evidence of cancer cells. As long as cancer cells are seen anywhere within the specimen, the surgeon continues to remove and examine tissue layers from that section of the wound until none are present. Because each layer is examined microscopically, dermatologists can be reasonably certain that allthe cancer has been eradicated and that no tumor nests are left behind. In addition, only the cancerous tissue is removed, saving as much normal skin as possible.
Before and After Surgery
Mohs micrographic surgery is commonly performed on an outpatient basis with a local anesthetic administered to the area around the tumor Surgery usually begins early in the morning and is finished the same day unless the tumor is extensive.
Because of the layer-by-layer removal, laboratory preparation and examination under the microscope are delicate and require great precision. They are also time consuming. If more than one session is needed to remove all signs of tumor, a dressing is applied. Once the area is declared cancer-free, your surgeon will discuss the options of wound healing or reconstructive surgery.
Periodic visits to your dermatologist are recommended to check on your progress and spot any possible cancer recurrence as soon as possible. One of five patients with one skin cancer will develop another within five years, so follow-up is extremely important for early detection of any new lesions.
Rationale for Mohs Micrographic Surgery
Cure rates for skin cancer after treatment with Mohs micrographic surgery are as high as 95 percent. The technique produces the smallest possible wound in the removal of any given tumor The smaller the wound, the greater are the chances for a good cosmetic result after the wound has completely healed. This is particularly important on the face, where a good appearance after surgery is of concern to the patient.
An overwhelming majority of tumors can be totally removed in one treatment session, due to the preciseness of the surgery and microscopic inspection.
While the Mohs surgery is a technically demanding procedure, it is also highly cost-effective, because fewer return visits to the dermatologist’s office are needed for treatment of a recurring lesion.
Who Performs Mohs Surgery?
The American College of Mohs Micrographic Surgery and Cutaneous Oncology currently recognizes 25 training centers in the United States where qualified applicants receive comprehensive training on Mohs micrographic surgery. Additional training centers are being recognized yearly.
The period of training on Mohs surgery is usually one year, during which time the dermatologist acquires extensive experience with all aspects of the technique. Once the physician’s training is successfully completed, he or she becomes eligible for membership in the College.
Many dermatologists throughout the country have been trained in the basicmicrographic surgical techniques and employ them in their practices. But, when patients require more extensive surgery, they are referred to a member of the College. Most major metropolitan areas now have at least one Mohs micrographic surgery center.