Mohs Surgery Santa Barbara
Mohs Surgery – Essentials You Should Know
The Mohs surgery procedure is a surgical technique used for the treatment of difficult or recurrent skin cancers. The procedure is performed under local anesthesia, and the skin cancer is removed with a very thin margin and processed and evaluated while the patient waits in the office. Each layer is carefully mapped and one person acts as both surgeon and pathologist so that if more tissue needs to be removed the exact location can be easily identified.
Mohs surgery is a highly successful treatment method with cure rates typically reported between 97% and 98.5% for many non-melanoma skin cancers. Other than high cure rate, the other key benefit of Mohs surgery is the preservation of all healthy tissue around the site of the skin cancer.
When and How Did It Originate?
Mohs surgery was first described by Dr. Frederick Mohs in the 1930’s and has evolved over the last century. The technique has become the gold standard for the treatment of difficult skin cancers.
Who Is a Good Candidate for Mohs Surgery?
Mohs surgery is a surgical procedure that has been used to treat many different types of skin cancer:
- Squamous cell carcinoma
- Basal cell carcinoma
- Lentigo Maligna (Melanoma In Situ on sun-damaged skin)
- Malignant melanoma
- Other non-melanoma skin cancers including atypical fibroxanthoma and merkel cell carcinoma
Mohs surgery may be a good option for treatment of a skin cancer for a number of reasons. Mohs is useful for aggressive types of skin cancers, including certain subtypes of basal cell carcinoma (e.g. infiltrative, morpheaform, metatypical subtypes). Mohs surgery may also be useful in areas with a limited amount of skin, such as eyelid, nose, lips, ears, because Mohs surgery begins with a much smaller surgical margin than standard surgical procedures. And Mohs surgery may also be useful for some skin cancers that are very poorly defined (i.e. can’t tell where the skin cancer ends and normal skin begins). Best option is to talk to your dermatologist or have a consultation with a fellowship-trained Mohs surgeon. The American College of Mohs Surgery (ACMS) recommends seeing a fellowship-trained Mohs surgeon (www.mohscollege.org). These physicians have completed a 1-2 year fellowship focusing on Mohs surgery, reconstruction and pathology processing and interpretation and helps to insure that your Mohs surgeon has had rigorous and complete training and experience in Mohs surgery. Dr. Kaufman has completed highly regarded fellowships in Mohs micrographic surgery.
The Mohs Surgery Procedure
The upside to Mohs surgery is higher cure rate and preservation of health tissue; the downside is that the patient needs to plan to be at the office for 3-4 hours. The reason for this is that the tissue is processed while the patient remains in the office so most of the time may be spent waiting as the tissue is processed and read by the doctor. Each time the tissue is taken it takes about one hour to process and read the tissue, which is really a very short period of time if you consider that it may have taken four to seven or more days to get the results from the original biopsy. So, in short, the procedure is actually very quick, but because of the meticulous tracing out of the roots of skin cancer, patients should plan to be at the office for 3-4 hours. Our in-office laboratory expedites processing and interpretation of each piece of tissue, and as one person acts as both surgeon and pathologist, the procedure occurs quickly and the results are very precise.
There are four general steps to Mohs surgery:
- Surgical removal of tissue. The area is cleaned and prepped and anesthetized with local anesthesia, similar to the prior biopsy. A very small 1-2 mm margin of tissue is removed around the healthy tissue (about 1/12- 1/25 of an inch). A larger margin may be necessary for melanoma. The orientation of the tissue on the patient is marked out.
- Mapping, freezing, and cutting of tissue. A map is drawn of the tissue and the tissue is marked so various borders can be identified under the microscope. The tissue is frozen so that it may be cut and processed, and 4-6 micron sections are taken and placed on a microscope slide. The slides are stained so that they can be visualized microscopically.
- Analysis of collected tissue. The doctor reads the microscope slide, interpreting whether any of the narrow surgical margins (e.g. deep or peripheral) are involved with tumor, and exactly where tumor extends. If tumor extends to one of the margins, it is marked on the map, and the doctor takes another stage of tissue from that region and repeats the process, essentially tracing out the roots of the skin cancer.
- Reconstructive surgery. Once the tumor is clear, the doctor evaluates the surgical defect and determines the best option for reconstruction. Or if the patient had preferred that another doctor or specialist perform the repair, the wound is bandaged, and the patient is sent out for the repair.
The surgical procedure allows a very detailed examination of the narrow surgical margins, essentially examining 100% of the margins, while preserving the greatest amount of healthy tissue since the surgical margins are much narrower than the recommended margins for standard surgical excision of skin cancers.
Since this is an outpatient surgical procedure, patients can usually leave the office when the procedure is complete. As the waiting and surgery can be tiring to patients, it is always a good consideration to have a friend or family member drive to and from the office.
Recovery and Post-Surgical Care
After reconstruction of the skin cancer wound, a pressure bandage is applied to the area. Detailed wound care instructions are given to the patient. Cool packs, elevation of the treated area and decreased activities help to decrease the chance of complications. Sutures are removed usually 7 days from the day of the surgery.
As patients with skin cancer have a higher risk of developing new skin cancers in the future, they should be seen by their dermatologist on a regular basis.
Dr. Kaufman is a fellowship-trained Mohs surgeon. Dr. Kaufman is a member of the American College of Mohs Surgery and a former member of the Board of Directors of that prestigious organization. He completed his fellowship at the University of California at San Francisco under the guidance of Drs. Roy Grekin and Richard Glogau.
Contact our office to set up a consultation with Dr. Kaufman regarding Mohs surgery.