The Skin Cancer Foundation Journal

MAY 2013

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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HEALTH Mohs micrographic surgery involves precise mapping techniques prior to processing and examination under the microscope. At left, Dr. Kline at the microscope checking tissue samples mid-surgery. At right, excised tissue samples from a patient's nose, with a map of extra tissue from the face or neck can have a potentially devastating effect not only on cosmetic appearance, but on simple daily functions such as drinking, smiling, and wearing glasses. Furthermore, what appears to be a small lesion requiring minimal treatment may be far more aggressive than it seems, harboring "roots" that extend unpredictably deeper or wider than what is visible on the skin's surface. In these cases, especially, precision and accuracy are of the utmost importance in achieving complete removal. Enter Mohs surgery. WHAT IS MOHS? Mohs micrographic surgery is a specialized surgical procedure most often used to remove high-risk skin cancers [Table 1]. It was developed by Frederick Mohs, MD, at the University of Wisconsin in the 1930's,3 then refned and expanded in use by physicians such as Perry Robins, MD. In Mohs surgery, the skin cancer is removed in stages. Thin layers of affected tissue are removed one at a time with a scalpel, from under and around the "roots" of the skin cancer, then carefully color-coded and mapped. The tissue is then processed by a technician, placed on slides, and examined by 58 showing where they were taken from on the nose. If any remaining cancer cells are found in either sample, the surgeon will know exactly where on the nose more tissue needs to be excised. the Mohs surgeon under a microscope. The careful mapping of the cancerous tissue enables the surgeon to pinpoint exactly where any residual tumor is located at the surgical site. Mohs surgery is unique in that the tumor's margins are also fully 98% Mohs Surgery has the highest success rate of all skin cancer treatments. evaluated under the microscope, while the patient remains in surgery. Dermatologists performing routine excisions often examine less than one percent of tissue margins, making the complete removal of skin cancer less certain; the surgeon cuts out the cancer that is visible with the naked eye plus a signifcant margin of normal-appearing skin to be on the safe side before ending the surgery, but undetected skin cancer may still be left behind, leading to continued growth and more extensive procedures later on. The Mohs surgeon, however, views all excised tissue layer by layer, and if any cancer is present at the margins, the surgeon simply removes another layer. The process continues until the last tissue reviewed under the microscope is free of skin cancer cells. The systematic precision and accuracy allow the complete removal of the tumor while minimizing the loss of surrounding normal tissue. This produces a smaller scar, a potentially superior cosmetic appearance, and a signifcantly lower risk of recurrence — the highest success rate of all skin cancer treatments. BCC and SCC cure rates can be 98 percent or higher. THE COST-EFFECTIVENESS OF MOHS SURGERY At first glance, skin cancer treatments such as simple excision may appear more cost-effective. However, Mohs does not require a hospital visit or general anesthesia, and the SK I N C A NCER FOU N DAT ION JOU R NA L

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