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Skin Cancer: Why Mohs Surgery is Used

By HERWriter
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Skin cancer is diagnosed in more than two million people each year, and one in five will develop skin cancer in their lifetime according to Skincancer.org. Many skin cancers occur on the face and their removal can be disfiguring.

During the 60s and 70s, a technique called Mohs microscopic surgery came of age and “is currently the most precise, tissue-sparing method for the treatment of basal cell and squamous cell carcinomas, the most common cancers in the United States.”

Mohs surgery has also begun to be used to treat certain types of melanoma. This is possible due to advances in special stains which are known as immunocytochemistry stains, which can better indentify the cells where melanoma occurs.

The unique feature of Mohs surgery is the meticulous testing of the tissue layers under the cancer. First, the doctor removes the visible lesion. Then, he removes a thin layer of skin underneath.

He maps and color-codes the margins of the lesion and microscopically examines the remaining skin to determine if it is cancer-free. If it is not, then he carefully removes another thin layer of skin until all the borders appear clear.

The Mohs method has shown a 99 percent cure rate for most cancers, reported Skincancer.org. It offers the highest chance of a cure in the treatment of recurrent cancers. Other sources state the cure rate is 96-99 percent, 94 percent for recurrent basal cell cancers.

Mohs surgery is often used when preservation of the maximum amount of skin is desired so lesions around the eyes, ears, nose, mouth, hairline, hands, feet and genitals are common locations for its use, stated Mayoclinic.com. It eliminates the need to guess and take larger amounts to ensure the cancer has been entirely removed.

Mohs surgery is also used when a cancerous lesion has borders that are difficult to determine, are very large or aggressive, and for those skin cancers that are known to have a high incidence of reoccurrence.

Mohs surgery is also best used for treatment of cancer in places that have received radiation treatment, have scars, and for immuno-supressed patients according to Perry Robins, MD. Robins was Chief of the Mohs Micrographic Surgery Unit at New York University Medical Center for more than 40 years.

While Mohs surgery sounds like it would be the preferred way to remove any skin cancer, there are situations where it is not the method of choice.

Melanoma continues to be treated using alternative methods since Moh’s surgery may not be able to clearly identify melanoma cells.

Mohs surgery is also a fairly time-consuming surgery, taking two to seven hours. Other surgeries to remove skin cancer are faster.

Lesions that appear in places where there is a lot of excess skin do not need to be so conservative in skin sparing, so larger amounts of skin and tissue can be removed.

In those cases, if the cancer does reoccur the person may need repeat surgeries.

Mohs surgery is also more expensive and may or may be not covered totally by insurance companies or Medicare. However, more insurance companies are recognizing that there may be a reduced need for additional surgery so Moh’s surgery can be more cost-effective to do.

If you and your dermatologist feel you have a lesion that would best be treated using Mohs surgery, you can find specially trained doctors through the American College of Mohs Surgery (ACMS) at http://www.mohscollege.org/acms/


Mohs surgery By Mayo Clinic staff. Mayoclinic.com. Retrieved June 10, 2012. http://www.mayoclinic.com/health/mohs-surgery/MY01304/METHOD=print

Moh’s Surgery. Skincancer.org. Retrieved June 10, 2012.

The Evolution of Moh’s Micrographic Surgery. Skincancer.org. Retrieved June 10, 2012.

Mohs Micrographic Skin Cancer Surgery. Skin Laser & Surgery Specialists of New York and New Jersey. Retrieved June 10, 2012.

Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues. Other articles by Michele are at www.helium.com/users/487540/show_articles/

Edited by Jody Smith

Add a Comment2 Comments

EmpowHER Guest

yes. it's really need.

October 11, 2012 - 3:09am
EmpowHER Guest

If you would like an alternative to surgery, consider SRT- superficial radiation therapy. SRT is specifically designed for non-melanoma skin cancer and has the same cure rates at Mohs. The procedure is simple, the dermatologist maps out the boundaries of the lesion and cuts a whole in a small lead shield to reveal the cancer. The SRT machine uses x-rays and targets the skin layer only. The actual treatment takes 30-45 seconds and performed about 10 times over two weeks. There is no pain, no cutting, no scarring, no corrective cosmetic surgery, no threat of nerve damage due to surgery, no interaction with current prescriptions (like blood thinners) that the patient my be taking. There are a few companies focused on SRT, AlerMed.com is one that specializes in bringing SRT services to your dermatologist.

June 13, 2012 - 11:55am
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.