MOHS MICROGRAPHIC SURGERY FOR SKIN CANCER

A diagnosis of skin cancer is a cause for real concern. If left untreated, the disease will continue to progress and can cause considerable damage, disfigurement or even death. However, skin cancer is usually not life threatening and therapy does not have to be disfiguring. If detected early, skin cancer can be treated successfully.

Mohs micrographic surgery is an advanced treatment for skin cancer that offers the highest potential for recovery -- even if other forms of treatment have failed. The cure rate for Mohs micrographic surgery is the highest of all treatments for skin cancer -- up to 99 percent.¹

ABOUT SKIN CANCER

Growth

Skin cancer is the most common and rapidly increasing form of cancer in the United States, according to the Centers for Disease Control and Prevention. About one in five Americans will develop skin cancer in his or her lifetime.

Skin cancer occurs when tissue grows at an uncontrollable and unpredictable rate forming tumors. Some tumors form a circular pattern while others have irregular extensions that are not always apparent to sight or touch. Some extensions grow on the skin's surface, but others may invade muscle, fat, connective tissue and even bone beneath the inner layers of skin.

Causes

Overexposure to sunlight, including tanning, is generally considered to be the principal cause of skin cancer. Family history is a strong indicator of risk in certain ethnic groups, especially those who have fair complexions or tend to bum and blister easily upon sun exposure. The more people with fair complexions are exposed to the sun, the more likely they are to develop skin cancer. Other causes include repeated medical and industrial x-ray exposure, scarring from bums, and occupational exposure to certain chemical compounds.

PREVENTION

Prevention of skin cancer is the best treatment. In general, the best practice is to limit the exposure of the skin to the sun, especially between the hours of 10 a.m. and 3 p.m. Sunscreens with a rating of at least 15 SPF should be used and reapplied approximately every two hours and after swimming.

It is important to note that 80 percent of sun damage occurs in the first 18 years of life, therefore a measure of prevention should be practiced at an early age.

EARLY DIAGNOSIS

The earlier skin cancer is identified, the more likely there will be a complete cure with no recurrence. Precancerous lesions, called actinic keratoses, are often found on the face and back of the hands of fair-skinned people who have had significant sun exposure. These small scaly spots may become skin cancer if not diagnosed and treated in the early stages.

A periodic self-examination helps to recognize any new or developing lesions. With a full-length mirror and a hand mirror in a brightly lit room, examine the torso of the body front and back, and then, with arms raised, right and left. With elbows bent, carefully examine the forearms, back of upper arms and palms. Use the hand mirror to examine the backs of legs and feet, the back, buttocks and the back of the neck and scalp. Be sure to also examine the soles of the feet and the spaces between the toes. It is important to note any changes in the skin or in existing growths or moles.

Signs of Skin Cancer

Any growth or mark that has changed, grown or looks suspicious may indicate the presence of skin cancer. The following signs should be promptly investigated:

• A new growth on the skin 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.

Many skin growths may look like skin cancer, but not all are malignant. Any suspicious-looking growth should be discussed with a dermatologist.

When detected early, most skin cancer responds to common treatment procedures. The treatment method chosen depends upon the location of the cancer, its size and the type of previous therapies, if any. Common treatments include curettage (scraping away of diseased tissue) electrodesiccation (destroying diseased tissue by electric current), cryosurgery (freezing diseased tissue), radiation therapy and standard surgical excision. In these therapies, the physician must make an educated estimate about the size of the tumor and the margins outside the tumor that must be removed for safety.

It is important to note that treatments that rely on the human eye to determine a safety margin may prove ineffective. More healthy tissue than necessary may be removed as a precaution and result in excessive scarring. When too little tissue is removed, the cancer may recur. Tumors that typically do not respond to the above treatments include:

• those greater than two centimeters in diameter
• those with edges that cannot be clearly defined
• those in difficult locations (i.e., eyelids, nose)
• tumors complicated by previous treatment and the presence of scar tissue

In these cases, treatment with Mohs micrographic surgery might be indicated.

The Mohs process includes a specific sequence of surgical and pathological investigation in which tissue is removed and examined for evidence of extended cancer roots. Once the visible tumor is removed, Mohs surgeons trace the paths of the tumor using two key tools:

• a map of the surgical site
• a microscope

Once the obvious tumor is removed, Mohs surgeons:

• remove an additional, thin layer of tissue from the tumor site
• create a "map" or drawing of the removed tissue to be used as a guide to the precise location of any remaining cancer cells
• microscopically examine the removed tissue thoroughly to check for evidence of remaining cancer cells

If any of the sections contain cancer cells, Mohs surgeons:

• return to the specific area of the tumor site as indicated by the map
• remove another thin layer of tissue only from the specific area within each section where cancer cells were detected
• microscopically examine the newly removed tissue for additional cancer cells

If microscopic analysis still shows evidence of disease, the process continues layer-by-layer until the cancer is completely gone. This selective removal of only diseased tissue allows preservation of much of the surrounding normal tissue. Because this systematic microscopic search reveals the complete roots of the skin cancer, Mohs surgery offers the highest chance for complete removal of the cancer while sparing the normal tissue.

Two weeks prior to surgery, you will need to discontinue all aspirin or aspirin-related products to avoid the risk of bleeding during and after surgery. The day before, avoid alcohol which is also a mild blood thinner. The day of surgery, you may eat a light breakfast and take other normal medications except for aspirin-containing products, and non-steroidal anti-inflammatories such as ibuprofen.

Surgery is performed under local anesthesia usually within a single visit. Most tumors require two to four stages for complete removal. There will be a one to two hour wait between each stage during which each small layer is meticulously examined for remaining cancer cells. In most cases, the Mohs surgeon will reconstruct the area of the wound on-site to achieve the best cosmetic results and to preserve functional capabilities.

Most patients have only minimal pain after surgery. A normal dose of Tylenol can relieve any discomfort. Some redness or swelling is normal, and it gradually decreases in less than a week. Bruising goes away in one to two weeks. However, should you experience extreme pain or sudden swelling, you should call your physician.

ABOUT THE MOHS SURGEON

The highly-trained surgeons that perform Mohs micrographic surgery are specialists in dermatology, pathology and reconstructive surgery. With their unique combination of training, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery.