MOHS & Skin Cancer Surgery
Treatment for Skin Cancer
Treatment for skin cancer varies according to the location, extent, and aggressiveness of the cancer and the patient’s general health. In most cases, Dr. Abrams will take a biopsy of the abnormal tissue. The tissue is sent to a laboratory and examined under a microscope by a dermatopathologist to determine whether it is malignant or benign.
Malignant tumors require more treatment such as curettage, surgical excision, cryosurgery, MOHS microscopically controlled surgery, topical chemotherapy, laser surgery or radiation therapy.
Electrodesiccation and Curettage involve scraping away the malignant tissue with a sharp surgical instrument called a curette. An electrosurgical unit may then be used to stop bleeding and remove a zone of normal tissue.
Surgical excision involves cutting into the skin, removing the growth, and then closing the wound with stitches.
Biopsy means to remove a small piece of the skin for examination under the microscope and diagnosis.
Cryosurgery involves the use of a machine that sprays liquid nitrogen directly onto the skin, or contacts the skin with an instrument, which freezes the cancerous tissue. Freezing can destroy cancer cells, and wound healing will occur with minimal scarring.
Mohs surgery is a way of removing a tumor where each bit of tissue is examined under the microscope to determine the site and extent of malignant cells before more tissue is removed. While the procedure is time consuming, it yields a very high cure rate and is indicated for recurrent tumors and tumors located in areas of high risk for recurrence, such as on and around the nose.
Topical chemotherapy involves the application of a chemical, 5-fluorouracil, which destroys precancerous growths and sometimes cancerous tissue.
Radiation therapy can also destroy cancerous tissue and is useful in certain types of skin cancer, as well as in selected individuals for whom surgery is not possible.
This unique form of surgery was developed over 50 years ago by Dr. Frederick Mohs, a professor of surgery at the University of Wisconsin. Since that time, the technique has been refined and advanced so that today it is offered by certified Dermatological Surgeons throughout the country.
Mohs surgery is performed by a team specially trained in this technique. The team includes a Mohs certified physician, surgical assistants, and a technician who is responsible for preparing the tissue for microscopic examination. Although Mohs surgery has a 99.8% cure rate, it is important to note that some tumors may recur even after Mohs surgery has been carefully performed.
Mohs Surgery Facts
The surgery is done in office. A local anesthesia is given into the area after which a thin layer of skin at the tumor site is then removed. This layer is marked, frozen and stained, so that it can be examined by Dr. Abrams under microscope. These steps will be repeated until the entire tumor is removed. Depending on the extent of the tumor, there may be several stages (layers) of surgery.
Since we cannot determine in advance how many stages you will require, you should plan to spend no less than 1 hour but potentially up to 6 hours at our office. The majority of patients are released within 3 to 4 hours.
Advantages of Mohs Surgery
The major advantage of this technique is that we only have to remove the cancerous tissue sacrificing little of the surrounding healthy skin. This is particularly important if the cancer is close to vital structures such as the nose, eyes, or ears. Of course any surgical procedure may leave a scar but by preserving the maximum amount of healthy skin, we hope to allow the best cosmetic result. In addition, by viewing the tissue under the microscope at the time of surgery, we can be more confident that the skin cancer has been removed.
Since we cannot know ahead of time the extent of the tumor, it is difficult to discuss the repair of the skin until the surgery is completed. Once the tumor has been completely removed, and we know the size and shape of the defect, we will discuss with you the best options for repair. Repairs are usually performed the day following surgery to avoid complications and prevent infections. For complicated extensive repairs, we may recommend a consultation with an approved plastic surgeon.
As with any procedure, there may be complications. Complications may include but are not limited to; scarring, infection, nerve damage, hematoma, allergic reactions, flap and graft necrosis, and seroma. Some bleeding during surgery is expected, although it is uncommon for this to occur during the post-operative period. Infection rarely occurs and is controlled by oral antibiotic.
You can expect some degree of scarring as a result of this procedure; however, it usually matures over several months and becomes acceptable cosmetically. Some scars will be pink and bumpy for three to nine months. Scars that do not mature well can often be revised. Most revisions are done 12 months after the original surgery.
Skin Cancer Types
There are two kinds of skin tumors, benign (non-cancerous) and malignant (cancerous).
The three types of skin cancer are Basal Cell Carcinoma, Squamous Cell Carcinoma, and Malignant Melanoma. Of those three, the least serious is the Basal Cell cancer.
Basal cell cancer typically appears as a shiny, small lump on sun-exposed areas of the skin. It is common for individuals who spend a lot of time outdoors without UVA/UVB protection. Though these types of tumors grow slowly, they can reach a very large size and penetrate deeply if they are not treated. They may often bleed, develop a crust, seem to heal, and then bleed again. Basal cell cancers have a high cure rate and are easily treated with minor out-patient surgery if detected early.
Squamous cell cancer may show up as a lump or red scaly growth. Untreated, squamous cell cancer can spread and even cause death. It is important to see a dermatologist as early as possible if you suspect that a lesion may be squamous cell. The dermatologist can perform a biopsy to diagnose the lesion and provide the appropriate treatment as needed.
Malignant melanoma is the least common but most serious form of skin cancer. It appears as a dark brown or black mole with uneven borders and irregular color, in shades of black/blue, red, or white. Malignant melanoma most commonly occurs on the upper backs of men, and on the lower legs of women, although it can also develop on the face and other areas of the body. It can spread to other organs (brain, bone, liver, lungs) and cause death. There is a rare form of melanoma that occurs in families with atypical moles. These individuals have many unusual moles, some of which may need to be removed.
Skin Cancer Prevention
At Abrams Dermatology we stress the importance of conducting annual skin exams and educate our patients how to conduc routine self-exams at home. A dermatological skin exam involves a complete assessment of the patient’s entire skin surface, hair and nails. During an examination, any skin conditions found is discussed with the patient to determine the proper treatment. Follow-up visits may be required in order to carry out the treatment plan or monitor the patient’ status if multiple procedures or medications are required.
Please refer to the diagrams below for instructions on performing a self-exam.
A skin exam is done if you have:
- Suspicious moles or skin lesions.
- Symptoms of early skin cancer.
- A history of previous skin cancer.
- 50 or more moles.
- Atypical moles (dysplastic nevi).
- A family history of skin cancer.
Self-Examination for Melanoma
Other signs of melanoma in a mole include changes in:
- Elevation, such as thickening or raising of a previously flat mole.
- Surface, such as scaling, erosion, oozing, bleeding, or crusting.
- Surrounding skin, such as redness, swelling, or small new patches of color around a larger lesion (satellite pigmentations).
- Sensation, such as itching, tingling, or burning.
- Consistency, such as softening or small pieces that break off easily (friability).
Other signs of skin cancer:
- A firm, transparent bump laced with tiny blood vessels in thin red lines (telangiectasias).
- A reddish or irritated patch of skin.
- A new, smooth skin bump (nodule) with a raised border and indented center.
- A smooth, shiny, or pearly bump that may look like a mole or cyst.
- A shiny area of tight-looking skin, especially on the face, that looks like a scar and has poorly defined edges.
- An open sore that oozes, bleeds, or crusts and has not healed in 3 weeks.
- A persistent red bump on sun-exposed skin.
- A sore that does not heal or an area of thickened skin on the lower lip, especially if you smoke or use chewing tobacco, or your lips are exposed to the sun and wind.