What Is The Mohs Procedure For Handling Skin Cancer?
I, Karl Loren, am going to have the Mohs Procedure done for ME! So, I've wanted to learn about it, and offer you the chance to learn with me!
How about YOUR question here?
Read below or choose another question.
I, Karl Loren, had a "bump" on my face, under my left eye -- diagnosed as the least dangerous of cancer -- skin cancer called basal cell carcinoma. I had a "regular" eye surgeon attempt to remove this in the usual way. After he finished, and got the report from the lab, he told me that he did "not get it all," and that additional surgery would be needed. He told me I would now need a "Mohs Procedure."
I went looking on the web, found the below, cleared this with my health insurance provider and have a consultation with the surgeon for Monday, October 20, 2003. I figured I would keep you posted here, if you are interested.
Since I am scheduled for hip replacement on October 29, 2003, the skin cancer surgery will undoubtedly wait until later in November, but I'll keep this page up to date.
Karl Loren
| About Mohs Micrographic Surgery |
Mohs Micrographic Surgery, an advanced treatment procedure for skin cancer, offers the highest potential for recovery—even if the skin cancer has been previously treated. This procedure is state-of-the-art treatment in which the physician serves as surgeon, pathologist and reconstructive surgeon. It relies on the accuracy of a microscope to trace and ensure removal of skin cancer down to its roots. This procedure allows dermatologists, trained in Mohs Surgery, to see beyond the visible disease, and to precisely identify and remove the entire tumor, leaving healthy tissue unharmed. This procedure is most often used in treating two of the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma.
The cure rate for Mohs Micrographic Surgery is the highest of all treatments for skin cancer—up to 99 percent even if other forms of treatment have failed. This procedure, the most exact and precise method of tumor removal, minimizes the chance of regrowth and lessens the potential for scarring or disfigurement.
History
Effectiveness
Treatment Issues
Indications
Procedure
Reconstruction
Cost Effectiveness
The Mohs Surgeon
History
Developed by Frederic E. Mohs, M.D. in the 1930s, the Mohs
Micrographic Surgical procedure has been refined and perfected for more than
half a century. Initially, Dr. Mohs removed tumors with a chemosurgical
technique. Thin layers of tissue were excised and frozen before being
pathologically examined. He developed a unique technique of color-coding excised
specimens and created a mapping process to accurately identify the location of
remaining cancerous cells.
As the process evolved, surgeons refined the technique and now excise the tumor, remove layers of tissue and examine the fresh tissue immediately. The chemosurgical technique developed by Dr. Mohs is no longer used. This reduces the normal treatment time to one visit and allows for immediate reconstruction of the wound. The heart of the procedure—the color-coded mapping of excised specimens and their thorough microscopic examination—remains the definitive part of the Mohs Micrographic Surgical procedure.
Effectiveness
Clinical studies have shown that Mohs Micrographic Surgery has a five-year cure
rate up to 99 percent in the treatment of basal cell and squamous cell
carcinomas.
Treatment Issues
Common treatment procedures often prove ineffective because they rely on the
human eye to determine the extent of the cancer. In an effort to preserve
healthy tissue, too little tissue may be removed resulting in recurrence of the
cancer. If the surgeon is overcautious, more healthy tissue than necessary may
be removed causing excessive scarring.
Some tumors do not respond to common treatments, including those greater than two centimeters in diameter, those in difficult locations and tumors complicated by previous treatment. Removing a recurring skin cancer is more complicated because scar tissue makes it difficult to differentiate between cancerous and healthy tissue.
Indications
Mohs Micrographic Surgery is primarily used to treat basal and
squamous cell carcinomas, but can be used to treat less common tumors including
melanoma. Mohs Surgery is indicated when:
Procedure
The Mohs process includes a specific sequence of surgery and
pathological investigation. Mohs surgeons examine the removed tissue for
evidence of extended cancer roots. Once the visible tumor is removed, Mohs
surgeons trace the paths of the tumor using two key tools:
Once the obvious tumor is removed, the Mohs surgeon:
If any of the sections contain cancer cells, the Mohs surgeon:
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 roots of the skin cancer, Mohs Surgery offers the highest chance for complete removal of the cancer while sparing the normal tissue. Cure rates exceed 99 percent for new cancers, and 95 percent for recurrent cancers.
Reconstruction
The best method of managing the wound resulting from surgery is
determined after the cancer is completely removed. When the final defect is
known, management is individualized to achieve the best results and to preserve
functional capabilities and maximize aesthetics. The Mohs surgeon is also
trained in reconstructive procedures and often will perform the reconstructive
procedure necessary to repair the wound. A small wound may be allowed to heal on
its own, or the wound may be closed with stitches, a skin graft or a flap. If a
tumor is larger than initially anticipated, another surgical specialist with
unique skills may complete the reconstruction.
Cost Effectiveness
Besides its high cure rate, Mohs Micrographic Surgery also has
shown to be cost effective. In a study of costs of various types of skin cancer
removal, the Mohs process was found to be comparable when compared to the cost
of other procedures, such as electrodesiccation and curettage, cryosurgery,
excision or radiation therapy. Mohs Micrographic Surgery preserves the maximum
amount of normal skin and results smaller scars. Repairs are more often simple
and involve fewer complicated reconstructive procedures.
With its high cure rate, Mohs Surgery minimizes the risk of recurrence and eliminates the costs of larger, more serious surgery for recurrent cancers. Because the Mohs procedure is performed in the surgeon’s office and pathological examinations are immediately, the entire process can often be completed in a single day.
The Mohs Surgeon
The highly-trained surgeons that perform Mohs Micrographic
Surgery are specialists both in dermatology and pathology. With their extensive
knowledge of the skin and unique pathological skills, they are able to remove
only diseased tissue, preserving healthy tissue and minimizing the cosmetic
impact of the surgery. Only physicians who have also completed a residency in
dermatology are qualified for Mohs Micrographic Surgical training.
The American College of Mohs Micrographic Surgery and Cutaneous Oncology currently recognizes more than 60 training centers where qualified applicants receive comprehensive training in Mohs Micrographic Surgery. The minimum training period is one year during which the dermatologist acquires extensive experience in all aspects of Mohs Surgery, pathology and training in reconstructive Surgery.
Find a Mohs Surgeon in your area.
Questions?
If you have further questions about the Mohs procedure you may contact the
American College of Mohs Micrographic Surgery and Cutaneous Oncology at (800)
500-7224 or info@mohscollege.org.
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Karl's Latest News
November 27, 2003
The information about the Mohs procedure, above, is still quite valid. Here is more of my personal story.
When the original doctor told me that he "didn't get it all" he certainly didn't act worried, nor did I worry. He described the "Mohs" procedure to me and said he would recommend that to the insurance company.
In due course I got the approval from the HMO, and called the doctor/surgeon for an appointment. I was just a bit suspicious, so I asked on the phone whether or not he did the Mohs procedure.
I must admit I don't recall the exact words, but I think, now, that he carefully did not answer that question, fully, but answered in such a way that I was sure he was a "Mohs surgeon."
When I got there for the consultation, he openly told me that he did not do the Mohs procedure but did something that he thought was just as good???
So, I was concerned, but listened carefully.
First, to remind you, the Mohs procedure is where ONE person, the surgeon, is qualified in three different specialties. He is a surgeon to cut out the skin cancer. He is also a pathologist to examine the cells he has just cut out -- to see if he "got it all." And, he is a "reconstructive plastic surgeon" to handle any "deep holes" he may have had to make to cut out the cancer.
The "cutting out" is simple, but worth repeating here.
The surgeon takes note of where the basal call cancer is -- and starts cutting it out from someone near the center. He then makes a cut in the shape of a "ring" around the outer edge of the cancer. This ring is very carefully cut out, and marked as a sample, then immediately examined under the microscope -- using the skill of a pathologist. If the pathologist finds ZERO cancer cells in that ring, that is considered to have "gotten it all out." If he finds just one cancer cell, anywhere in that ring, the man then becomes again the surgeon and cuts another ring, just a small bit further out -- this could be just a few millimeters further. This ring, like the other, is carefully labeled, as a sample, and then immediately examined under the microscope -- the same doctor now being the pathologist. He keeps doing this until he gets a "clear ring" with no cancer cells.
That's it for the surgery.
Now, he has been cutting away, and become very aware of how much of a hole or pocket he has made on the skin. If the skin cancer, as is mine, is very near the eye, then there is every chance that he has cut out a piece of flesh that will leave some disfigurement there, on the face.
I'm not sure that the plastic reconstructive surgery is done in the same five minutes, but at least the same doctor, probably on a later visit, then moves some flesh around, or does his magic, so that any hole that had been made is "fixed."
The doctor I went to was, indeed, a surgeon for cutting, and also a plastic surgeon. He was not a pathologist and he said that when HE did this type of work there would be another doctor in the operating room at the same time, with him and me, and that this separate doctor was the pathologist, and would do the tissue examination immediately -- no difference from the Mohs procedure except it was a more highly trained guy doing the examination.
He then explained that the HMO would not approve any plastic surgery, even for rather deep pockets or disfiguring -- so that he could not do any plastic surgery on me, under the insurance coverage, but that if I wanted to pay for that, he could do it.
I decided I could wait to look at the "hole" but figure that it probably won't be deep enough to worry about.
That procedure is scheduled for December 5, 2003, at St. Joeseph's Hospital in Burbank. It is a "day surgery" that may take a few hours just because they are very conservative when they do the cutting -- cutting only very small rings, taking there time to study these samples under the microscope, and then cutting more if necessary.
There would be only local anesthesia, and I could leave the hospital and go home with no particular "recovery" problem.
I do not anticipate any complications and just view this as a minor surgery.
I will probably add a final note to this page after December 5th to report on the actual outcome.
I would not hesitate to recommend this procedure to anyone who has a skin cancer -- they are the least dangerous of any cancers. They are never treated with chemo or radiation -- but only with surgery of the type I've described.
Karl Loren
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