Skin Cancer and Mohs Chemosurgery

Micrographic Surgery and Cutaneous Oncology

Skin Cancer and Mohs Micrographic Surgery

Cancer is the growth of abnormal cells. 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: one person out of every 150 will develop one of these malignant moles sometime in life)

These cancers all originate in the skin, and if left untreated will invade adjacent tissue or spread widely (metastasize). Untreated melanoma often spreads early and can be rapidly fatal. Squamous cell carcinoma can metastasize, but not commonly. Basal cells are the most common cancer, but rarely metastasize, although they too will slowly grow (invade) into surrounding areas and can destroy bones, muscles and nerves.

Unlike other forms of cancer in internal body organs, skin cancer can be seen without the aid of sophisticated medical equipment. Patients notice the lesions early and can seek treatment in the early stages, while their cancers are still small and can be easily cured.

The Signs of Skin Cancer

Skin cancer occurs in a number of ways. If you notice any of the following signs or symptoms, see your doctor as soon as possible.

• A new growth on the skin of an adult that does not disappear in four weeks.
• 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 for four weeks to itch, hurt, crust over, form a scab, erode or bleed.
• A skin lesion that grows larger and turns brown, black or multicolored.
• A mole, birthmark, or beauty mark that changes in size, color or texture or becomes irregular in shape. Change in color or contour is dangerous in a mole.

Prevention

Skin cancers are usually the result of damage to the skin cells by years of sun exposure. Sun damage is cumulative. We never escape the effect of any sunshine we are exposed to at any time of our lives. It all keeps adding up. Premature aging of the skin is also caused by too much sun. Common sense precautions can prevent further damage.

• Avoid outdoor activities during peak sunlight hours-10:00 AM to 3:00 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 often, particularly if swimming or perspiring. Don't be fooled by cloudy or overcast days-damaging radiation can still get through. People with light complexions who do not tan easily or those with family history of skin cancer should be especially careful about excessive sun exposure.
• Beware of light reflecting surfaces such as sand, snow and water, which magnify the potential harm to skin. Use special caution 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 to the skin as is the sun.

The Importance of Biopsy

There are many benign skin growths or lesions that resemble skin cancer but are found not to be cancerous when seen under a microscope. Often a biopsy is the only way to distinguish between a cancer and a sun damage spot (actinic keratosis), innocent mole or wart.

Treatment

Time-honored techniques for the treatment of skin cancer include:

• Electrodesiccation
• Surgical Removal
• Irradiation Removal
• Cryotherapy Removal
• Mohs Micrographic Surgery -99% cure rate in lesions not treated previously A painstaking and technically demanding technique for removing cancerous tissue. More precise than standard surgery; faster and less costly than irradiation.

Each of the techniques meets a different need. Your doctor will discuss with you and choose for you the treatment guaranteeing the best result for your skin cancer. No one technique is the best for all.

When is Mohs Surgery Appropriate?

The concept of Mohs micrographic surgery was developed in 1936, but relatively few surgeons were trained in its use until recently

Only in the last few years has Mohs surgery become widely available throughout the country.

Mohs micrographic surgery is now universally recognized as the most precise method for treating skin cancers. It is especially effective for cancers of the face and other cosmetically sensitive areas, as it can remove all the cancer cells while causing minimal damage to the surrounding normal skin. It does not control spread after the cancer has reached the lymph nodes; it is designed to control cancer before it spreads.

Mohs micrographic surgery is also the best choice for the removal of recurrent skin cancers (tumors that reappear after treatment). Individual cancer cells left behind can be microscopically small, yet they will cause the tumor to reappear. The Mohs technique removes these areas with extreme accuracy, even in hard to predict situations.

What is the Mohs Technique?

Mohs micrographic surgery is named for Dr. Frederick Mohs of the University of Wisconsin, who developed the basic technique in 1936. It is called by several names: Mohs surgery, chemosurgery, microscopically controlled surgery or histographic surgery-it's all the same. In the years since the conception, many technical improvements and refinements have made micrographic surgery a swift, safe and highly effective means of treating skin cancer.

The major difference between Mohs surgery and other methods of removing skin lesions is the microscopic accuracy. In Mohs surgery, thin, horizontal sheets of the cancer are removed. This tissue is mapped on a grid pattern, with each grid line carefully identified and color stained by the surgeon so that its exact location can be pinpointed on the wound.

Each layer of tissue removed is inspected under the microscope for the presence of cancer cells. The surgeon continues to remove tissue and examine it layer by layer until no cancer cells are seen. The microscope allows the surgeon to be reasonably certain no tumor nests or scattered cells remain. In this process, very little healthy tissue is removed. From the patient's viewpoint, saving normal skin is especially important on easily visible and hard-to-replace areas such as the nose, lips and eyelids.

Before and After Surgery

Mohs surgery is usually performed on an outpatient basis using a local anesthetic. Surgery begins in the morning and is finished the same day unless the tumor is extensive. This includes the delicate laboratory preparation and microscopic examination, which is done immediately after surgical removal of each layer of tissue. One benefit of this approach is that the anesthesia rarely has a chance to wear off and doesn't need to be readministered.

If more than one layer is needed to remove all signs of tumor, a dressing is applied and you are asked to wait about 60 minutes for each layer. During this time you may leave for comfort stops, rest, or to have lunch.

Once the area is declared cancer-free, your surgeon will discuss with you how to dress the wound and what you can expect in the healing of your wound. Reconstructive surgery is not often needed unless the wound is quite large.

Follow-up visits are recommended at periodic intervals for one to five years. This is necessary to detect possible cancer recurrence. If the area is left to heal, primarily a scar will form. This scar will soften in time but requires care to follow-up to be sure.

One out of five patients with one skin cancer will develop a second skin cancer within five years. New skin cancers will be referred back to your regular doctor for his decision as to the best form of therapy.

Advantages of Mohs Surgery
Better .. Faster .. Cheaper

Cure rates for previously untreated skin cancer after treatment using Mohs surgery are as high as 99%. Larger, neglected lesions, or recurrent lesions will have a slightly poorer cure rate.

An additional benefit is that the technique produces the smallest possible wound, allowing for faster healing and a better cosmetic result, which is particularly important on the face and especially on the nose.

Many tumors can be totally removed in one treatment session, due to the rapidity of frozen microscopic sections, Occasionally, paraffin-treated microscopic sections are needed for cancers affecting deeper tissues, for which the faster frozen section technique cannot yield reliable results. Paraffins require slow overnight preparation in the lab, and sometimes next-day surgery, but are invaluable for their precision and microscopic accuracy.

Costs for Mohs surgery are kept low because the surgery can usually be performed in the doctor's office.

The Mohs Specialist

The exacting nature of the Mohs procedure has in the past limited the practice of Mohs surgery in this country. Dr. Greco completed his undergraduate study, M.D. degree and performed two years of internal medicine residency at the University of Toronto. He completed his dermatology training at McGill University in Montreal, Quebec. Dr. Greco is board certified by the American Board of Dermatology and the Royal College of Physicians and Surgeons of Canada. He is also a Fellow in the American Society for Moh's Surgery.

Patients beyond a comfortable driving distance from Mount Pleasant can usually be finished the same day.

Moh's surgery is covered by all major private insurers, Medicare and Medicaid.

For appointments, please call (903) 577-8878. Or click here to make your appointment online.