What You Need To Know About Skin Cancer and Mohs Micrographic Surgery
Mohs Micrographic Surgery for Skin Cancer
A diagnosis of skin cancer is a cause for real concern. If left untreated, skin cancer may progress to cause considerable damage, disfigurement or even death. However, the most common types of skin cancer are not immediately life threatening, and the treatment does not have to be disfiguring. Early detection and treatment with Mohs micrographic surgery can significantly improve the success of skin cancer therapy.
Mohs micrographic surgery is an advanced treatment for skin cancer that offers the highest potential for recovery – even if other forms of treatment have failed.The cure rate for Mohs micrographic surgery is the highest of all treatments for skin cancer – up to 99 percent.
Skin Cancer Growth
Skin cancer is the most common and rapidly increasing form of cancer in the United States, according to the Centers for Disease Control and Prevention.About one in five Americans will develop skin cancer in his or her lifetime.
Skin cancer occurs when tissue grows at an uncontrollable and unpredictable rate forming tumors.Some tumors form a circular pattern, while others have irregular extensions that are not always apparent to sight or touch.Some extensions grow on the skin’s surface, but others may grow beneath the skin and invade fat, muscle, and even bone.
Causes of Skin Cancer
Chronic overexposure to sunlight is generally considered to be the principal cause of skin cancer.Those who have fair complexions or tend to burn and blister easily upon sun exposure are particularly susceptible.The more people with fair complexions are exposed to the sun, the more likely they are to develop skin cancer.Other causes include repeated medical and industrial x-ray exposure, scarring from burns, and occupational exposure to certain chemical compounds.Family history is an important determinant of a susceptibility to melanoma.
Skin Cancer Prevention
Prevention of skin cancer is the best treatment.In general, the best practice is to limit the exposure of the skin to the sun, especially between 10 a.m. and 3 p.m.Sunscreens with a rating of at least 15 SPF should be used and reapplied approximately every two hours and after swimming.
It is important to note that 80 percent of sun damage occurs in the first 18 years of life; therefore prevention should be practiced at an early age.
Early Diagnosis
The earlier skin cancer is identified, the more likely there will be a complete cure with no recurrence.It is important to note any changes in the skin or in existing growths or moles.Precancerous lesions, called actinic keratosis, are often found on the face and back of the hands of fair-skinned people who have had significant sun exposure.These small scaly spots may become skin cancer if not diagnosed and treated in the early stages.
Self-Examination
A periodic self-examination helps to recognize any new or developing lesions.With a full-length mirror and a hand mirror in a brightly lit room, examine the torso of the body front and back, and then, with arms raised, right and left.With elbows bent, carefully examine the forearms, back of upper arms and palms. Use the hand mirror to examine the backs of legs and feet, the back, buttocks and the back of the neck and scalp.Be sure to also examine the soles of the feet and the spaces between the toes.
Signs of Skin Cancer
Any growth or mark that has changed, grown or looks suspicious may indicate the presence of skin cancer.The following signs should be promptly investigated:
·a new growth on the skin that does not disappear in four to six weeks
·any skin lesion that grows larger and turns red, brown, black or is multicolored
·a mole, birthmark or beauty mark that increases in size, changes color or texture or becomes irregular in outline
·an open sore or wound that refuses to heal, persists for more than four weeks or heals and later reopens
·any skin spot or growth that continues to itch, hurt, crust over, forms a scab or sore, or bleeds for several weeks.
Many skin growths may resemble skin cancer, but not all are malignant.Any suspicious-looking growth should be discussed with a family physician or dermatologist.
Treatment
When detected early, most skin cancer responds to common treatment procedures.The treatment method chosen depends upon the location of the cancer, its size and the type of previous therapies, if any. Common treatments include curettage (scraping away of diseased tissue), electrodesiccation (destroying diseased tissue by electric current), cryosurgery (freezing diseased tissue), radiation therapy and standard surgical excision.With these therapies, the physician must make an educated estimate about the size of the tumor and the margins outside the tumor that must be treated.
It is important to note that treatments that rely on the human eye to determine a safety margin may prove ineffective.More healthytissue than necessary may be removed as a precaution and result in excessive scarring.When too little tissue is removed, the cancer may recur.Tumors that typically do not respond well to the above treatments include:
-those greater than two centimeters in diameter
-those with edges that cannot be clearly defined
-those in difficult locations (i.e., eyelids, nose)
-tumors recurring after previous treatment or arising in scar tissue.
In these cases, treatment with Mohs micrographic surgery might be indicated.
About the Mohs Micrographic Surgery Procedure
The Mohs process includes a specific sequence of surgical and pathological investigation in which tissue is removed and examined for evidence of invisible roots of cancer.Once the visible tumor is removed, Mohs surgeons trace the paths of the tumor using two key tools:
-a map of the surgical site
-a microscope.
Once the obvious tumor is removed, Mohs surgeons:
-remove an additional, thin layer of tissue from the tumor site;
-create a “map” or drawing of the removed tissue to be used as a guide for the precise location of any remaining cancer cells;
-microscopically examine the removed tissue thoroughly to check for evidence of remaining cancer cells.
If any of the sections contain cancer cells, Mohs surgeons:
-return to the specific area of tumor as indicated by the map;
-remove another thin layer of tissue only from the specific area where cancer cells were detected;
-microscopically examine the newly removed tissue for additional cancer cells.
If microscopic analysis still shows evidence of disease, the process continues layer by layer until
the cancer is completely gone.This selective removal of only diseased tissue allows maximum preservation of the surrounding normal tissue.Because this systematic microscopic search reveals all the roots of the skin cancer, Mohs surgery offers the highest chance for complete removal of the cancer while sparing normal tissue.
What to Expect if You Have Mohs Surgery
The day prior to surgery, avoid alcohol, which is a mild blood thinner that increases the risk of bleeding during surgery.The day of surgery, you may eat a light breakfast and take your normal medications except for non-steroidal anti-inflammatories such as ibuprofen.
Surgery is performed under local anesthesia, usually during a single visit.Most tumors require two to four stages for complete removal. There will be a one to two hour wait between each stage during which each small layer is meticulously examined for remaining cancer cells.In most cases, the Mohs surgeon will reconstruct the wound immediately to achieve the best cosmetic results and to preserve function.
Most patients have only minimal pain after surgery.A normal dose of acetaminophen or similar analgesic can relieve most discomfort.Some redness or swelling is normal, and it gradually decreases in less than a week.Bruising goes away in one to two weeks.However, should you experience extreme pain or sudden swelling, call your physician.
About The Mohs Surgeon
The highly trained surgeons that perform Mohs micrographic surgery are specialists in dermatology, pathology and reconstructive surgery.With their unique combination of training, they are able to remove only diseased tissue, preserving maximum amounts of healthy tissue and minimizing the cosmetic impact of the surgery.
