skin cancer &
mohs surgery
skin cancer
Approximately 1 in 5 Americans will develop skin cancer by the age of 70. More people are diagnosed with skin cancer each year than all of cancers combined. This form of cancer is highly treatable when detected early. Skin cancer does not discriminate. Anyone can get it, regardless of skin color. The likelihood of skin cancer increases with age. Skin cancer most commonly is found on areas of the body that are exposed to the sun.
When caught early, skin cancer is highly treatable. This is why we stressed the importance of routine skin exams with our patients.
Treatment begins with a proper diagnosis. In order to diagnose skin cancer, we perform a full skin exam during an office visit. If a lesion is suspicious, a small portion of it maybe sampled for testing. That specimen is carefully stain and examined in a laboratory. If the sample is shown to be cancerous, we will determine the type of skin cancer you have and discuss the appropriate treatment options for you.
(Click each condition below to read more)
SKIN CANCER PREVENTION
Follow these tips to help you detect and prevent skin cancer:
- Perform skin self-exams: examine your skin often.
If you notice anything changing, itching or bleeding on your skin, immediately make an appointment with us. - Protect your skin every day by:
- Seeking shade to protect you from the sun’s harmful UV rays especially during the hours of 10:00 a.m. and 2:00 p.m. when the sun’s rays are strongest.
- Taking care around water, snow and sand which reflect and intensify the sun’s damaging rays.
- Wearing protective clothing including long-sleeved shirt, pants, wide-brimmed hat and sunglasses when possible.
- Generously apply a broad spectrum, water resistant sunscreen with an SPF of 30 or higher. Daily use of sunscreen can cut your risk of developing melanoma by half!
- Reapply sunscreen every two hours or after swimming or sweating.
- Avoiding tanning beds.
ACTINIC KERATOSIS
Actinic keratosis (of solar keratosis) is a precancerous lesion found on sun-exposed skin affecting more than 58 million Americans. It appears a scaly, red, sometimes hard spots. Researchers estimate that they have a 1-10% chance per year to develop into a true cancer known as squamous cell carcinoma. Squamous cell carcinoma is a potentially deadly form of cancer that does metastasis and can lead to death is untreated. Many routine treatments are available for precancers including cryotherapy, photodynamic therapy, and chemical peels.
BASAL CELL CARCINOMA
Basal cell carcinoma is the most common type of cancer in humans. An estimated 4.3 million cases of basal cell carcinoma are diagnosed in the US each year resulting in more than 3,000 deaths. It can appear on the skin in many shapes and sizes. It may appear as a dome-shaped growth with visible blood vessels, a tiny pink patch or a sore that repeatedly heals then returns. This type of cancer if left untreated will become painful, bleed, and grow deep into the tissue and bone. Basal Cell Carcinoma is most commonly found on the scalp, face, nose, and neck.
SQUAMOUS CELL CARCINOMA
Squamous cell carcinoma is the second most common type of skin cancer. More than 1 million cases of squamous cell carcinoma are diagnosed each year resulting in more than 15,000 deaths annually. It appears on the skin in many shapes. It may appear as a crusted or rough bump, a red, rough flat patch, a dome-shaped bump that grows and bleeds or a sore that does not heal or heals then returns. Squamous cell carcinoma commonly develops on skin exposed to the sun but may also develop on areas of the body that is not exposed to the sun. The HPV virus in warts can result in squamous cell carcinoma as well. Left untreated, this form of cancer can spread to other parts of the body making treatment difficult if not discovered and treated early.
MELANOMA
One person dies of melanoma every hour. Furthermore, the number of new melanomas diagnosed annually has increased by 53% in the past decade. Melanoma is the deadliest form of skin cancer developing on both sun-exposed and non-sun exposed skin. An estimated 9,320 people with die of melanoma in the US this year. A change in the shape, color or size of a mole can be a sign of melanoma. Moles that become painful or begin to bleed or itch can also be signs of melanoma. When detected early, melanoma is highly treatable. If you have a mole that is concerning, call to schedule an appointment today.
Mohs Surgery
Mohs micrographic surgery is the gold standard for treating skin cancer. It is an advanced method of treatment offering the highest cure rate. Often skin cancers have a various roots not visible to the eye. Using a microscope, a Mohs surgeon is able to trace and fully remove the entire tumor with leaving healthy tissue intact and unharmed.
Methods to treat skin cancers
There are many available methods to treat skin cancer including traditional surgical excisions, Mohs surgery, electrodessication and curettage, cryotherapy, radiation, or chemotherapy. For tumors in cosmetically sensitive or difficult areas (ie head, neck, hands/feet, shins, and genitals), large tumors, cancers previously attempted to be treated, those with aggressive histological features, or poorly defined tumors, Mohs surgery offers the highest rate of completely removing the cancer while sparing the surrounding healthy tissue.
Why remove skin cancers with Mohs Surgery?
In Mohs surgery, the surgeon acts as both the surgeon and the pathologist. The specialized technique for processing the tissue allows for every cell along the margin of tissue removed to be examined. This allows for the surgeon to ensure that every single cancer cell has been removed during the procedure and that a maximum amount of healthy tissue remains. The cure rates for Mohs surgery are superior to surgical excision with frozen sections were only a few samples of the whole specimen are examined with the hope that the sample represents the entire tumor. In comparison, traditional surgery exams approximately 5% of the margin of skin cancer as opposed to Mohs surgery which offers 100% margin control.
MOHS history
Mohs surgery was developed by Dr. Fredrick Mohs at the University of Wisconsin over 50 years ago. While the process used to take days, advances have allowed the process to be refined to allow for the procedure to be performed in a few hours.
MOHS procedure
Mohs surgery is comfortably performed in the office under local anesthesia. Mild oral sedation is available for patients that request it. This is much safer than using general anesthesia which puts the patient to sleep and reduces recovery time with fewer side effects.
Once the anesthesia has taken effect, the physician will remove the visible skin cancer, process it in the onsite Mohs lab. A dressing is applied to the wound and the patients returns to the waiting room. Refreshments, magazines, and television are available while the tissue is being examined. In the Mohs lab, the tissue is carefully processed and mapped in a three dimensional method. The physician reads the processed tissue with the aid of a microscope and prepares a map of any remaining tissue.
If cancer cells are still present at the edges of the removed tissue, the patient returns for an additional layer of tumor to be taken. More anesthesia is given and the patient made comfortable. Using the map of the remaining tumor as a guide, the physician carefully removes another layer of tissue only in the areas where the tumor remains. The process repeats itself until the entire cancer is 100% removed. Most tumors are removed in 1 or 2 layers and each layer takes about 45 minutes to an hour to process and examine.
Once the tumor is completely removed, the wound is repaired. The specific needs of the patient and the resulting defect are evaluated, discussed, and reviewed with the goal to maximize aesthetics and maintain functional capabilities. Most wound are able to be closed in a small straight line with stitches. Others may require a small flap or skin graft to close.
Fellowship Trained Mohs Surgeon
A Mohs surgeon is a specially trained dermatology who removes skin cancers and is also undergone specific training in the fields of pathology and reconstructive surgery. A fellowship is a rigorous and intensive training one undertakes after graduating from medical school and in addition to completing a full dermatology residency. Chosen though an extremely competitive review and selection process, fellows are trained in a large number of Mohs surgery cases and reconstructions under a very senior and experienced mentor. This is in addition to a number of scientific research projects they must complete on the field of Mohs surgery before graduating.
Fellowship trained Mohs surgeons are then invited to be members of the American College of Mohs Micrographic Surgery, the oldest professional organization of physicians specifically trained in Mohs surgery.
frequently asked questions
(Click each question below to read more)
WHAT IS MOHS SURGERY?
Mohs surgery is named after the surgeon who developed it, Dr. Fredrick Mohs at the University of Wisconsin. It is the gold standard of skin cancer removal offering the highest cure rates and leaving behind the most amount of health tissue.
HOW LONG WILL THE SURGERY TAKE?
Each layer of tissue examined takes about 45 mins to an hour to process. If cancer is still present, an additional micrographic layer is taken. Most tumors are cleared in 1 or 2 layers with the resulting repair taking 15 to 30 minutes.
WHAT SHOULD I BRING TO THE OFFICE?
We suggest patients bring a sweater or jacket because the surgery rooms are often kept at a cooler temperature. Shirts that button to allow for easy removal and into a gown are helpful for your convenience. A snack, book, and companion are often helpful as well.
WILL I NEED TO STOP MY BLOOD THINNER SUCH AS ASPIRIN, COUMADIN, OR PLAVIX?
Most people do not have to stop their blood thinner. For those anxious about their procedure and risk of post operative bleeding, we ask they discuss stopping their medication with their heart doctor to see if they are health enough to stop their blood thinner. For those who take aspirin, ibuprofen, or other NSAID’s for pain or routine heart health prevention not prescribed by a doctor, we recommend you avoid them if possible for two weeks prior to surgery.
WILL MY INSURANCE COVER MOHS SURGERY?
Most insurances cover Mohs surgery and the wound repair.
WILL I BE ABLE TO DRIVE MYSELF HOME AFTER THE PROCEDURE?
Only local anesthesia is used and the patient is able to drive themselves home. Although a companion is welcomed and can be helpful on the day of surgery, it is not necessary. For those wishing for oral mild sedation, a drive is needed.
DO I NEED TO BE FASTING FOR THE PROCEDURE?
In fact, a good meal before coming is best.
WHAT HAPPENS ONCE THE MARGINS ARE CLEAR AND ALL THE TUMOR IS REMOVED?
Once cancer has been completely removed, the wound is evaluated and repaired. Approximately 80% of wounds are repaired with a straight line closure. Others may require a small flap or skin graft.
WHAT SUPPLIES WILL I NEED FOR MY AFTER-CARE?
We will discuss in detail how to care for your surgery site on day of the procedure as well as give a handout. Non-adherent gauze pads, Vaseline or Aquaphor, paper tape, Tylenol, and an ice pack are all that are typically required.
WILL I NEED ANTIBIOTICS OR PAIN PILLS?
We discuss this on a case by case basis with the patient, but the vast majority of cases do not require either. Less than 5% of all patients require the need of pain pills or oral antibiotics. However, we will address your specific case, needs, and medical history to determine what is most appropriate for you and your care.
Schedule an Appointment
While Mohs surgery has many advantages, it may not be the right treatment for every patient or every instance of skin cancer. We consider many factors before determining if this surgery is the right one for you. If you have been diagnosed with skin cancer and want to discuss whether the Mohs process is appropriate for you, please call to schedule a consultation with our staff.
