Mohs Surgery was developed in the 1930's by Dr. Frederic Mohs, and was primarily used to remove tumors and tissue for further examination. Over time, this chemosurgical technique has evolved into a technological advancement that has changed the recovery and treatment of skin cancers entirely and has been established as the gold standard and practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all roots and extensions of the cancer can be eliminated.
Mohs Micrographic Surgery is most frequently used to treat basal cell and squamous cell carcinomas, but it is also ideal to treat less common skin tumors. Mohs surgery is always indicated when:
• The cancer was treated previously and recurred.
• Scar tissue exists in the area of the cancer.
• The cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as the face, eyelids, nose, ears, lips, fingers and toes.
• The cancer is large.
• The edges of the cancer cannot be clearly defined.
• The cancer is growing rapidly or uncontrollably.
Mohs Surgery is also required for recurrent skin cancers when other cancer treatment attempts have failed, as it is highly successful regardless of previous attempts to remove and keep the cancer from recurring. For most new skin cancers the cure rate is 99%. While the success rate in treating a recurrent skin cancer (previously treated cancer) by conventional means is often as low as 50-80%, the success rate for Mohs surgery in treating recurrent skin cancers remains high at 95-98%.
Mohs Surgery is an outpatient procedure performed in our office. Office based procedures help to keep the medical cost at a minimum and the safety at a maximum. Only local numbing medicine is required (no general anesthesia). Although the patient is awake during the entire procedure, discomfort is usually minimal and no greater than it would be for more routine skin cancer surgeries or your initial biopsy. The Mohs procedure typically starts in the morning and can be completed the same day, depending on the extent of the tumor and the amount of reconstruction necessary. Occasionally there may need to be a delayed reconstruction for more complex challenging tumors which would be done at a later date. During the Mohs procedure, the tumor is removed and the surrounding area is examined further with a microscope to find any remaining cancer cells that may have been left behind. Small sections are removed and mapped out in order to determine in which direction the cancer is growing. Additional sections are taken depending on whether there are remaining skin cancer cells seen under the microscope. Additional tissue is removed only where cancer is present. This process is repeated as many times as necessary to locate and remove any remaining cancerous roots. When microscopic examination reveals that there is no remaining tumor, the surgical area is ready to repair.
Mohs Micrographic Surgery is not only highly effective, but relatively inexpensive compared to other forms of skin cancer removal. In addition, because of its success rate, it does not require additional procedures or treatments, and the skin cancer is typically removed during just one visit or treatment, versus other procedures which require multiple doctor visits and surgeries to fully remove the cancer and surrounding cancerous cells with greater risk of further spread of the tumor if not properly treated the first time.
If you are worried about or been diagnosed with a skin cancer, call Dr. Lee today to see if she can help use Mohs Micrographic Surgery to remove your cancerous cells and tumors and keep you cancer-free for years to come!
Qualifications of the Mohs Surgeon:
It is important that you verify that your Mohs surgeon is recognized as a fellowship-trained surgeon. Only members of the American College of Mohs Surgery (ACMS) are fellowship trained to perform Mohs surgery. All members and fellows of the ACMS are listed on their website directory.
The link to the ACMS website: http://www.mohscollege.org/
Board-certified dermatologists who are fellowship-trained in Mohs surgery have specialized skills in dermatology, dermatologic surgery, dermatopathology, and Mohs micrographic surgery. In addition, the fellowship-trained Mohs surgeon must have the required surgical and laboratory facilities, and be supported by a well-trained Mohs staff. The American College of Mohs Surgery (ACMS) is the only certifying body in America that requires extensive training (over 500 cases per year) as well as demonstrated proficiency in complex plastic surgery reconstruction and experience managing rare and difficult tumors. This one to two year fellowship training can only occur following the successful completion of a dermatology residency and board-certification in dermatology. The surgical training is performed under the direct supervision of a fellowship Director recognized and approved by the American College of Mohs Surgery. Most doctors have not done this extensive training. Dr. Christine Lee was trained in dermatology and then did her fellowship training in Mohs surgery and cosmetic surgery at the prestigious University of California, San Francisco. She has performed thousands of Mohs surgery cases with reconstructive surgery.
Dr. Christine Lee’s Training Background:
After her dermatology training, Dr. Christine Lee was awarded a position in a highly sought after and competitive fellowship at the University of California, San Francisco. She completed a distinguished fellowship in Mohs Micrographic Surgery/Skin Cancer Surgery/Facial Plastic Reconstruction, Laser and Cosmetic Surgery, and Advanced Dermatologic Surgery from the University of California, San Francisco, one of the most prestigious training sites in the country for Mohs surgery, dermatologic surgery, dermatology and cosmetic dermatology. She is a long-standing member and fellow of the American College of Mohs Surgery and has performed thousands of Mohs surgery cases with complex reconstruction (plastic surgery). She is also highly trained and in expert in laser and cosmetic surgery. Her expertise in these fields will allow her to not only offer the highest cure rate for skin cancer but also ensure the best optimal cosmetic appearance after removing the skin cancer.
Potential Complications Associated with Mohs Surgery
Patients should understand that there is not an absolute guarantee that any given procedure will be totally free of complications or adverse reactions. Mohs surgery is no exception. During surgery, tiny nerve endings are cut, which may produce a temporary or permanent numbness in and around the surgical area. If a large tumor is removed or extensive surgery is required, occasionally a nerve to muscles may be cut, resulting in temporary or permanent weakness in a portion of the face. This is, however, an unusual and rare complication that can usually be avoided. The surgical area may remain tender for several weeks or months after surgery, especially if large amounts of tissue were required to be removed. Rarely, some patients experience intermittent itching or shooting pain in the surgical area for 12 to 16 months after skin cancer surgery. In addition, rarely the skin grafts and flaps used in plastic surgery to cover surgical areas may not fully heal at first, requiring additional repair or laser procedures or just tincture of time.
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