Skin Cancer Surgery Center

Mohs Micrographic Surgery

Mohs Micrographic Surgery, also known as chemosurgery, is a procedure designed to excise entire lesions of skin cancer utilizing frozen section histology. It is most effective in removing primary basal cell carcinomas, but is also used for removing squamous cell carcinoma and melanoma-in-situ.

Mohs is a revolutionary skin cancer treatment; it is the most advanced technique for removing skin cancer. It features the highest cure rate for basal cell and squamous cell carcinomas, and some melanomas, with the least amount of tissue removed.

The procedure was developed by Fredrick Mohs. Initially, it utilized a paste applied to the fresh wound of partially removed skin cancer and allowed it to dry overnight. This thin slice of tissue would become anesthetized, removed and observed under a microscope. If any cancer remained, the paste would be reapplied and the patient would return the next day until no cancer remained.

As technology and medicine have improved, the thin slices of tissue can be anesthetized and removed consecutively; once the previous slice has been observed and all cancerous findings mapped, the next piece is removed immediately, allowing the procedure to last less than a day.

The most significant advantage to Mohs Surgery is its extremely high success rate. Studies have shown that primary basal cell carcinoma removal has a 97-99% cure rate, while squamous cell carcinoma is considered to be successful approximately 94% of the time. Melanoma-in-situ removal success ranges from 75-95%, depending heavily on the skill of the surgeon.

Mohs surgery is often performed by four different specialists: dermatologic surgeon, histotechnician, pathologist, and reconstructive surgeon. The dermatologist is responsible for removal of the slides, while the histotechnician prepares them for microscopic use by flattening and mounting them. The pathologist observes and closely maps the locations of the cancer in the slide and lets the dermatologist know when the cancer has been completely removed. The reconstructive surgeon is responsible for closing the wound with special cosmetic proficiency.

Although one well trained doctor could handle all of these positions simultaneously, it is most common for the pathologist position to be filled by an individual with extreme expertise in both the disease and microscopy. It is also possible for a full team of four or more specialists to perform the operation. No matter how the work is divvied up, communication and smooth transition through each phase should be perfected to ensure the most efficient procedure possible.

Unfortunately, all surgical procedures carry the risk of scarring, and Mohs surgery is no different. However, the dermatologist performing Mohs surgery can utilize multiple methods to further prevent visible scarring to the affected area. The most common approach is for the surgeon to simply integrate stitching into natural skin crevices or out-of-sight areas, such as underneath the jaw line. This can be embellished using a “skin-flap” to shift the unsightly skin into one of these hidden places. Another less common practice is to allow a specialized plastic/reconstructive surgeon to perform the closure, normally at the behest of the patient.

It is important to note that the size and location of the tumor heavily influence scarring potential. The procedure itself is designed to minimize tissue excised due to the small surgical margin of one millimeter, therefore naturally leading to less scarring.

*This information was obtained from the
ACMS Website – Mohs Overview

Learn more about Mohs surgery from:

American College of Mohs Micrographic Surgery and Cutaneous Oncology
www.mohscollege.org


Skin Cancer Surgery

Skin cancer is the most common form of cancer in the United States. These malignant growths can form anywhere on the body, but most frequently appear on skin that is exposed to the sun. More than a million new cases of skin cancer are reported in the US every year. Although most cases of skin cancer can be successfully treated, it is still important to keep skin safe and healthy while trying to prevent this disease.
There are three major types of skin cancer that affect associated layers of the skin. These major types are:
  • Squamous cell carcinoma
  • Basal cell carcinoma
  • Melanoma

Causes

Every day, many skin cells die while new ones arise to replace them. This process is controlled and propagated by DNA. Skin cancer can form when this process does not work properly because of damage to DNA. This damage may cause new cells to form when they are not needed, or older cells may not die after they have lost function. This can cause a growth of unproductive tissue known as a tumor.
Ultraviolet (UV) radiation from sunlight and tanning lamps frequently cause damage to the DNA of the skin when exposed for long periods of time. Since skin cancer can sometimes affect areas not exposed to the sun, heredity may also be a factor.

Other risk factors for skin cancer include: fair skin, moles, a weakened immune system and age.

Signs and Symptoms

Skin cancer can often be identified as a new or altered growth on the skin. It may occur on the scalp, face, lips, ears, neck, chest, arms, hands or legs. The appearance of the growth depends on the type of cancer, but it may manifest as:
  • Pearly or waxy bump
  • Flesh-colored or brown scar-like lesion
  • Firm, red nodule
  • Crusted, flat lesion
  • Large brown spot with darker speckles
  • Mole that changes shape or color
  • Shiny, firm bumps

Diagnosis

Source: NCI Visuals Online. Skin Cancer Foundation. visualsonline.cancer.gov

It is important to see your doctor if you notice any skin changes. Early detection is imperative in successfully treating skin cancer. Regular full body screening is recommended as well. A biopsy is performed to properly diagnose suspected cancerous growths.

Treatment

Treatment for skin cancer depends on the type, size and location of the tumor. Most options remove the entire growth and are usually effective. Removal procedures are usually simple and require only a local anesthetic in an outpatient setting. Some of the treatment options for skin cancer include:

Freezing – also known as cryosurgery, kills tissue by freezing it with liquid nitrogen
Excision – the abnormal tissue, as well as some surrounding healthy tissue, is cut out of the skin
Laser therapy – destroys cancerous growths with little damage to surrounding tissue and few side effects
Mohs surgery – removes larger skin growths layer by layer until no abnormal cells remain to prevent damage to healthy skin
Chemotherapy – uses drugs to kill cancer, may be applied through creams or lotions for top layer tumors


Other treatment options are also available, including new methods that are currently being studied.

Although most treatment for skin cancer is successful, new tumors can still form. It is important to practice preventive measures and see your doctor on a regular basis. You can also perform self skin checks to spot any changes as soon as possible.


Skin Cancer Fact Sheet

  • Substantially more than 1 million cases of skin cancer are diagnosed in the United States every year.
  • Basal cell and squamous cell carcinomas are the two most common forms of skin cancer, but are easily treated if detected early.
  • Current estimates are that one in five Americans will develop skin cancer in their lifetime.
  • The incidence of melanoma has been steadily increasing for the past 30 years. Since 1992, melanoma has increased 3.1 percent annually in non-Hispanic Caucasians, but in recent years it is increasing more rapidly in young white women (3.8 percent since 1995) and men age 65 and older (8.8 percent since 2003).
  • Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.
  • Melanoma is increasing faster in females 15-29 years old than males in the same age group. In females 15-29 years old, the torso is the most common location for developing melanoma, which might be due to high-risk tanning behaviors.
  • Melanoma in individuals 10-39 years old is highly curable, with five-year survival rates exceeding 90 percent.
  • One in 58 men and women will be diagnosed with melanoma during their lifetime. Caucasians and men older than 50 years of age are at a higher risk of developing melanoma than the general population.
  • It is estimated that there will be about 121,840 new cases of melanoma in 2009 — 53,120 noninvasive ( in situ ) and 68,720 invasive (39,080 men and 29,640 women).
  • One American dies of melanoma almost every hour (every 61 minutes). In 2009, 8,650 deaths will be attributed to melanoma — 5,550 men and 3,100 women.
  • The World Health Organization estimates that as many as 65,161 people a year worldwide die from too much sun, mostly from malignant skin cancer.
  • People with more than 50 moles, atypical moles, or a family history of melanoma are at an increased risk of developing melanoma.
  • About 75 percent of skin cancer deaths are from melanoma.
  • The five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent.
  • Five-year survival rates for regional and distant stage melanomas are 65 percent and 15 percent, respectively.
  • In 2004, the total direct cost associated with the treatment for non-melanoma skin cancer was $1.5 billion.
  • The American Cancer Society recommends a skin cancer-related checkup and counseling about sun exposure as part of any periodic health examination for men and women beginning at age 20.
  • Individuals with a history of melanoma should have a full body exam at least annually and perform regular self-exams for new and changing moles.

 

For more information, or to schedule an appointment with Dermatology Associates of NJ please call 732-679-6300 or 732-780-7870.

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