Skin Cancer Mohs Surgery
Just recently I noticed a strange raised spot under my left eye. Another was just above my left eyebrow. I was not too concerned, since I have had a few precancerous growths removed by my dermatologist without them growing back. My skin is very fair, and as a teenager, I remember laying out in the sun during the hot months of the summer to get a golden tan. Also, I have lived in the South Pacific Islands for the last forty years, and I am exposed to the sun almost year round. However, these spots were a bit different.
I visited my dermatologist and showed her the areas on my face that looked unusual. She looked carefully and decided to burn them. This involves taking a metal instrument and zapping the suspicious area, or using liquid nitrogen, both of which hurt. Since the spot is so close to my eye, it made my tears start to flow (I was not really crying!). After about six weeks, I returned to my dermatologist to show her that both growths had reappeared. She then informed me that she would do a biopsy to see if it was indeed cancerous.
This was the first time I had a growth that came back after "burning" it. I then was told about Mohs Micrographic Surgery. It is the latest advancement in health technology for those with squamous cell or basal cell carcinoma.
I used to work in a Pathology Department of a hospital. I was aware of skin biopsies and knew the histologist well. He would take the biopsy, freeze and slice the specimen, and then mount it on a slide for the Pathologists to inspect. They would then make a diagnosis depending on the pattern of the cells found in the tissue. This old way of handling skin cancer often took several days for results before treatment could begin, and if any cancer was missed - another surgery had to be done. With the Mohs method, the physician can potentially get all of the cancerous cells the first time. Also, they are trained in the best way to treat the area after surgery for less scarring.
Who discovered Mohs Surgery?
Dr. Frederic Mohs developed this technique in the 1940s, but it has undergone many improvements and refinements to become an effective and efficient way to treat skin cancer.
The tissue is removed in layers and examined carefully. The edges of the tissue are dyed and mapped out and processed onto slides. While the patient is still waiting, the specimen is studied carefully under a microscope to determine if all of the cancer cells have been removed. If the edges show any malignant cells, another layer of skin is taken, and the process repeated until no more cancer cells are detected. The surgeon leaves as much healthy skin as possible.
Training for Mohs Surgery
Doctors who train for this technique undergo at least a year beyond their dermatology residency to learn this specialized process. They are trained specifically in:
- Removing skin cancer
- Mapping and analyzing microscopic tissue
- Repairing the wound and reconstruction to minimize scarring
What is Success Rate?
Mohs surgery patient have 99 percent cure rate for those with basal cell carcinoma and 95 percent cure rate for those with squamous cell carcinoma.
Who can benefit most from Mohs Surgery?
- Skin cancer that is on the eyelids, nose, ears, fingers, toes, lips and genitals is best treated with Mohs to preserve function and appearance.
- Those with recurring skin cancer
- Those with large skin cancers or those with scar tissue within cancer area
- Those with rapidly growing or uncontrollable skin cancer (sclerosing or infiltrating).
I am glad that I live in a time where technology has improved for those with skin cancer. If my diagnosis is positive for carcinoma (which I am not hoping for), I will have the chance to tell you my personal experience with Mohs Micrographic Surgery. Wish me luck!