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Learn About Mohs

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From Your Doctor

Decrease your risk for getting Skin Cancer

Despite risks, many believe that suntans look healthy and attractive. As children and adults we are exposed to dangerous Ultraviolet (UV) radiation from the sun.



More than 90% of all skin cancers are the result of exposure to ultraviolet radiation. UVA rays may have a significant effect on the development of melanoma, the most dangerous type of skin cancer. UV exposure can damage your immune system and your skin, causing a wrinkled, leathery appearance or premature aging.

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Skin Cancer

Skin cancer is by far the most common malignant tumor in humans. More than 1.2 million Americans are diagnosed with skin cancer each year. The most common types of skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. Both basal cell carcinoma and squamous cell carcinoma begin as a singe point in the upper layers of the skin and slowly enlarge, spreading both along the surface and downward. These extensions or "roots" of the tumor cannot be directly seen. The tumor roots often extend far beyond what is visible on the surface of the skin. Often, what is seen by you or your physician is the "tip of the iceberg" and much of the tumor may be under the skin where the eye cannot detect. If not completely removed, both types of skin cancer will continue to grow wand invade and destroy structures in their path. Metastasis (distant spread) of basal cell carcinoma is extremely rare and usually occurs only in the setting of long-standing large tumors or when the patient’s immune system is compromised. Squamous cell carcinoma is a more dangerous skin cancer, and patients must be observed for any spread of the tumor. Such spread is still infrequent.

Excessive exposure to sunlight (especially beginning in childhood) is the single most important factor associated with the development of skin cancers. In addition, the tendency to develop these cancers appears to be hereditary in certain ethnic groups, especially those with fair complexions and poor tanning abilities. Fair-skinned people develop skin cancers more frequently than dark-skinned people, and the more sun exposure they receive, the more likely they are to develop a skin cancer. Other factors, including exposure to radiation, trauma and exposure to certain chemicals, may also be involved in the development of skin cancers. The vast majority of skin cancers are present for more than a year before being diagnosed, as their growth is often slow. Skin cancers may be more aggressive in certain instances: patients whose immune system is compromised, patients with a medical history of leukemia or lymphoma, or cancers in certain location s such as the ear, lips, lower nose and around the eyes.

Treatments for Skin Cancer

There are five standard methods for treatment of skin cancers. The two non-surgical treatments are Cryotherapy (deep freezing) and radiation therapy. The three surgical methods include simple excision, physical destruction (curettage and electrodessication) and Mohs micrographic surgery. Other experimental methods under investigation include photodynamic therapy and immunotherapy.

In the past, Mohs micrographic surgery was sometimes called chemosurgery or Mohs chemosurgery. Originally, chemicals were applied to the skin during the surgery and hence, the name chemosurgery. Chemicals are now rarely used, but the name chemosurgery may continue to be associated with the procedure.

Mohs micrographic surgery is the state-of-the-art treatment for skin cancers where the Mohs surgeon acts as the surgeon, pathologist and reconstructive surgeon. It is named after the surgeon Dr. Frederick Mohs who pioneered this precise technique. Mohs surgery relies on the precision and accuracy of a microscope to identify and map out roots of the skin cancer to give the higher chance that the entire tumor will be removed, greater than any other form of treatment for skin cancers. No surgeon or technique can guarantee 100% chance of cure. However, in most circumstances, the chance of cure with Mohs surgery exceeds 97%.

Mohs micrographic surgery allows for the selective removal of the skin cancer with the preservation of as much of the surrounding normal tissue as is possible. As a result, Mohs micrographic surgery is very useful for: 1) larger tumors, 2) tumors with a more infiltrated or "finger-like" growth pattern, 3) tumors with indistinct borders, 4) tumors near a vital functional or cosmetic structures (eyes, nose), 5) tumors previously treated and 6) tumors located in areas with higher chance to recur (nose, around the nose, ears, around the eyes, lips or around the lips, and temple areas).

The surgical area will be cleaned and draped with sterile towels. Dr. Davis will then anesthetize (numb) the skin containing the cancer by a small local injection. We will be as gentle as we can when administering this injection. After the tissue has been removed, it will be processed in our office laboratory. Your wound will then be bandaged and you will move to the waiting area while your tissue is processed for examination by Dr. Davis. Depending on the amount of tissue removed, processing takes approximately 1 hour. If the microscopic examination of the removed tissue reveals tumor roots, we will go back to the precise area and remove more tissue to be processed in the laboratory. The Mohs technique allows us to precisely map out where the roots of the cancer remain. Most skin cancers are removed in 1-3 surgical stages.

Reconstruction

After the skin cancer has been completely removed, a decision is made on the best method for closing the wound created by the surgery. These methods include letting the wound heal in by itself, closing the wound side-to-side with stitches, or closing the wound with a skin graft or flap. The best method is determined on an individual basis, after the final defect is known.

Most of the wound closures are performed in our office. However, other surgical specialists may be involved for their unique skill, if a tumor turns out to be much larger than initially anticipated. We individualize your treatment to achieve the best results. When the reconstruction is scheduled to be completed by other surgical specialties, that reconstruction may take place on the next day or two. There is no harm in delaying the reconstruction for several days.

After Mohs Surgery

Your surgical wound will likely require care during the week(s) following surgery and prior to removal of the stitches. Detailed written instruction will be provided. You should plan on wearing a bandage and avoiding strenuous activity for the days following surgery. Please do not leave for travels during the week following your surgery to ensure proper medical evaluation if any problems result. Most of our patients report minimal pain, most of which will respond to Tylenol®. An ice pack (or bag of frozen vegetables) may also help with pain and reduce swelling, especially around the eyes. You may experience a sensation of tightness across the area of surgery. Supplies needed for wound care include: hydrogen peroxide, Q-tips®, petroleum jelly or Aquaphor® and often a form of bandage.

Skin Cancers frequently involve nerves and months may pass before your skin sensation returns to normal. In rare instances, some numbness my be permanent. You may also experience itching as your wound heals. Complete healing of the surgical scar takes place over a period greater than one year. Especially during the first few months, the scar site may feel thick, swollen or lumpy. Some redness is normal. This redness is due to the increased size and number of blood vessels in the area of surgery. The redness usually fades after several months. Gentle massage of the area (starting about 1 month after the surgery) will speed the healing and softening process.

An indefinite follow-up period of observation is necessary after the wound has healed. You will be asked to return to the office in several weeks and to your referring physician afterwards. The reason for closer follow-up is to monitor the healing process and also to closely follow if the cancer should recur. Studies have shown that once you develop a skin cancer, there is a strong possibility of developing another skin cancer in the future. Should you notice any suspicious areas, it is best to check with your referring physician for a complete examination. You will be reminded to return to you dermatologist frequently for continued surveillance of your skin.

Risks of Surgery / Important Points

As with and type of surgery, there are possible complication and risks that may occur. Because each patient is unique, it is impossible to discuss all the possible complication and risks in this format. The usual risks or expected outcomes are summarized below. Dr. Davis will discuss any additional risks associated with your individual case. Please understand that significant complication are the exception and not the rule.

The defect or wound created by the removal of the skin cancer and its underlying roots will often be larger than anticipated. This is due to the fact that skin cancer seen on the surface is actually often the "tip of the iceberg" and frequently more of the tumor is underneath the surface where only the microscope can see it. There often is no way to predict the final size of the wound prior to surgery.

There will be a scar at the site of removal. There is no such thing as "scarless surgery". We will make our best efforts to obtain optimal cosmetic results. Again, Mohs surgery will leave you with the smallest possible wound, thus creating the best opportunity for optimal cosmetic results.

There may be poor wound healing. At times, despite our best efforts, for various reasons (such as bleeding, poor physical condition, smoking, diabetes, or there diseases), healing may be slow or the wound may re-open. Flaps and grafts utilized to repair the defect may at times fail. Under these circumstances, the wound will usually be left to heal on its own and you will require close follow-up care.

There may be loss of motor (muscle) or sensory (feeling) nerve function. Rarely, the tumor invades or wraps around nerve fibers. When this is the case, the nerves must be removed along with the tumor. Prior to surgery, Dr. Davis will discuss with you any major nerves, which may be near your tumor.

The tumor may involve an important structure. Many tumors are near or on vital structures such as eyelids, nose or lips. If the tumor involves these structures, portions of them may have to be removed with resulting cosmetic or functional deformities. Furthermore, repairing the resulting defect may involve some of these structures.

Rarely, wounds become infected (fewer than 1%) and may require antibiotic treatment. The typical signs of infection are increasing pain, inflammation, unusual discharge/odor from the wound, and increased heat in the wound area. If you are at particular risk for infection, you may be given an antibiotic prior to surgery.

There may be excessive bleeding from the wound. Such bleeding will be controlled during the surgery. There may also be bleeding after surgery. If you experience bleeding after surgery, apply firm pressure over the wound with a clean cloth or towel for 30 minutes. Significant blood loss is very rare, but bleeding into a sutured graft or flap may inhibit good wound healing and thus increase the chance for the graft or flap to fail or not "take". Call the office if there is a sudden firm swelling near the wound site.

There may be an adverse reaction to medications used. We will carefully screen you for any history of problems with medications; however, new reactions to medications, can, but rarely occur.

There is a small chance that the tumor could recur after surgery. Previously treated tumors and large, long-standing tumors especially have an increased chance for recurrence.

Wound care post operative Mohs

After visiting our clinic it is vital to observe proper wound care when postoperative. Each doctor will provide specific instructions on how to care for your skin once leaving our clinic.

Skin Cancer FAQ

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  • 505.243.SKIN (7546)
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