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Is Mohs Surgery Used For Squamous Cell Carcinoma

What Does Basal Cell Carcinoma Look Like

Mohs micrographic surgery skin cancer treatment basal cell carcinoma squamous cell melanoma

When the DNA in the basal cells is damaged and a basal cell carcinoma develops, it will appear as a change in the skin, such as a growth or sore that wont heal. The lesion will have one of the following characteristics. It will look like

  • A pearly white, skin-colored, or pink bump on the skin. It will be translucent, meaning you can see through it slightly, and you can often see blood vessels in it.
  • A brown, black, or blue lesion or a lesion with dark spots. It will have a slightly raised, translucent border.
  • A flat, scaly, reddish patch of skin with a raised edge. These will occur more commonly on the back or chest.
  • A white, waxy, scar-like lesion without a clearly defined border. This morpheaform basal cell carcinoma is the least common.

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What Are The Treatments For Squamous Cell Carcinoma

The office of Ali Hendi, MD, offers Mohs surgery to treat squamous cell carcinoma. This highly specialized procedure involves the use of a surgical instrument and a microscope to slice away all of the cancer cells carefully.

If you need a skin cancer check or Mohs surgery, call the office of Ali Hendi, MD, today or book an appointment online.

Are There Risk Factors For Developing Merkel Cell Carcinoma

  • Merkel cell polyomavirus infection This virus was first discovered in 2008, and its still somewhat of a mystery. This virus is found in the cancer cells of 80 percent of people with Merkel cell carcinoma.
  • UV light exposure Exposure to the ultraviolet rays is the major risk factor . This exposure can come from the sun, tanning beds, or from UV light treatments for psoriasis.
  • Fair skin Nearly 90 of Merkel cell carcinomas occur in white people.
  • Old age This form of skin cancer is very rare in people under the age of 50. Over 80 percent of cases form in those over 70. This is probably due to a combination of accumulating UV exposure and a weakening immune system.
  • Males Men are twice as likely to get this skin cancer, although again that can simply be a factor that men get more sun exposure.
  • Weakened immune system Our immune systems not only fight germs and viruses, they also help the body fight cancer. When these systems are weakened, the patient becomes more likely to develop some types of cancer, including Merkel cell carcinoma.

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How Aggressive Is Squamous Cell Carcinoma

Squamous cell carcinoma is not often considered to be life threatening. This form of skin cancer that affects the squamous cells tends to create slow-growing tumors. Although squamous cell carcinoma is more likely to invade deeper layers of the skin and spread to other parts of the body than basal cell carcinoma, this is still uncommon.

Only about 5 to 10 percent of squamous cell carcinoma tumors are considered to be aggressive.

How Does Mohs Micrographic Surgery Work

Keratoacanthoma Right Lateral Canthus

The procedure is done in stages. After the affected area has been numbed with local anesthesia, the doctor uses a scalpel to excise the cancer in a disklike shape, says Dr. Leffell. When using the standard technique of simple excision, the surgeon must remove the tumor and cut a wide margin around it to ensure that she is removing as many of the abnormal cells as possible.

But with Mohs surgery, the doctor can start with a narrower excision and use a scalpel to remove just what is visible and can then later remove more if necessary.

The specimen is then brought to a laboratory that is a part of the Mohs unit. The specimen is divided into pieces and carefully mapped using different colors of ink. The tissue pieces are then processed in the lab and studied under the microscope by the Mohs surgeon, who can check the margins around the edges and underneath the tumor. Then the surgeon returns to the patient and removes another layer of cancerous tissue, if needed. In about 50 percent of cases, only one layer is needed to clear the cancer.

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The Steps Involved In Mohs Surgery

Mohs surgery is usually undertaken as a single day procedure under local anaesthesia. It involves the following steps:

  • The visible tumour plus a small margin is outlined using a skin marker, and a reference map or grid is drawn on the patient .
  • The area is excised at an angle of 3045 degrees at the radial margins.
  • Haemostasis is obtained and the wound is temporarily dressed.
  • The excised tissue sample is divided in two or more sections that are colour coded using special tissue dyes.
  • A mapping process ensures that residual tumour seen under the microscope can later be matched to the exact location on the patient using a paper based map or digital photographs and image processing software .
  • A specialised histotechnician or biomedical scientist embeds and freezes the tissue in a cryostat to create horizontal sections of the entire excision margin.
  • The Mohs surgeon examines the microscopic sections for remaining cancer.
  • Any remaining cancer is precisely drawn on the map or digital image.
  • This map or image is then used to identify the area on the patient from which more tissue needs to be removed.
  • See step 2. The process is repeated until the patient is tumour free.
  • The wound is closed, see wound closure topic for an overview of techniques.
  • See clinical images of Mohs surgery

    What Are The Symptoms Of Merkel Cell Carcinoma

    Merkel cell carcinoma usually starts on areas of skin exposed to the sun, especially the face, neck, arms, and legs. It first appears as a single pink, red, or purple shiny bump that doesnt hurt. These can bleed at times.

    These tumors grow quickly, and they can form new lumps near the first location. They can spread to nearby lymph nodes. If this happens the lymph nodes can grow so that they become visible as lumps under the skin. This usually occurs in the neck or under the arm.

    Merkel cell carcinoma is rare, and the first signs of it can look like more common forms of skin cancer that arent as aggressive. That makes early detection critical, as in many cases only a biopsy will identify it as Merkel cell carcinoma.

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    The Most Effective Technique For Treating Common Skin Cancers

    Mohs surgery is considered the most effective technique for treating many basal cell carcinomas and squamous cell carcinomas , the two most common types of skin cancer. Sometimes called Mohs micrographic surgery, the procedure is done in stages, including lab work, while the patient waits. This allows the removal of all cancerous cells for the highest cure rate while sparing healthy tissue and leaving the smallest possible scar.

    It began as a technique called chemosurgery, developed by Frederic E. Mohs, MD, in the late 1930s, but was not widely known. In the mid 1960s, Perry Robins, MD, studied the procedure with Dr. Mohs, and recognized that it had great potential for the field of dermatology. He brought the technique to NYU, where he established the first fellowship training program to teach dermatologists this skin cancer surgery. Dr. Robins helped advance the procedure into what is now called Mohs surgery and went on to teach and promote it around the world.

    for a skin cancer that has not been treated before

    How Long Can You Live With Squamous Cell Skin Cancer

    What is Mohs Surgery?

    The prognosis of this condition is excellent, with the cure rate approaching 99-100% if diagnosed and treated early. But therapeutic success significantly wanes for widespread and recurring lesions, high-risk subtypes and if the patient has poor health status. Once the malignancy spreads outside the skin, the chances of surviving after five years fall below 50% even with aggressive intervention.

    Patients require frequent follow-ups during the first 5 years after treatment because 95% of those who experience recurrences do so within this time.

    Individuals with a first-time lesion have a 30-50% chance of developing another nonmelanoma skin cancer in 5 years and generally a higher melanoma risk. Reducing UV exposure and other modifiable risk factors greatly reduces these odds.

    Early-stage squamous cell skin cancer treated with photodynamic therapy

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    Can Mohs Treat Melanoma

    Yes, dermatologists occasionally recommend Mohs for treating melanoma, the most serious type of skin cancer. Mohs is only used to treat an early melanoma, and it must be a type of melanoma called lentigo malignant melanoma. This type of melanoma stays close to the surface of the skin for a while.

    When treating melanoma, the surgeon uses a modified type of Mohs surgery called slow Mohs. Its called slow because the patient must wait longer for the results. Its not possible for the surgeon to look at the removed skin and know right away whether it contains cancer cells. More time is needed.

    If you have slow Mohs, the surgeon will remove the visible skin cancer and a bit of normal-looking skin around it. Youll then be bandaged and sent home.

    Most patients return the next day. Its then that the patient learns whether more skin must be removed or the wound can be closed. Again, some wounds are left to heal on their own.

    What Is The Difference Between Mohs Surgery And Standard Excision

    In standard excision, the tissue sample is sent off for histological processing while the wound is closed. The processing takes a number of days during which cross sections are created at various distances through the sample and are microscopically assessed by a pathologist. The pathologist looks for skin cancer at the margins of each section, but these are only a fraction of the actual excision margin.

    In Mohs surgery, the histological processing takes place on the day of surgery and the wound is only closed after it has been confirmed that the entire cancer has been removed. The excision margin is examined by an embedding technique that allows horizontal sections to be cut involving all the deep and radial excision margins. If any tumour is visible in these sections, it means that the excision is incomplete and the patient requires a further Mohs stage.

    A mapping process and colour coding system is used during Mohs surgery to precisely localise any remaining cancer, and tissue is only removed if it contains cancer. This process preserves healthy tissue.

    Mohs surgery yields higher clearance rates than standard excision, and smaller wounds therefore better cosmetic results.

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    Surgery For Basal And Squamous Cell Skin Cancers

    Surgery is a common treatment for basal cell and squamous cell skin cancers. Different surgical techniques can be used. The options depend on the type of skin cancer, how large the cancer is, where it is on the body, and other factors. Most often the surgery can be done in a doctors office or hospital clinic using a local anesthetic . For skin cancers with a high risk of spreading, surgery sometimes will be followed by other treatments, such as radiation or chemotherapy.

    Who Can Perfrom Mohs Surgery

    Preoperative ENT Consultation to Ensure Optimal Oncologic ...

    Generally, the only doctors who perform Mohs surgeries are dermatologists. When Mohs surgery has been recommended, many people worry about scarring. The Mohs surgery requires the doctor to cut away the diseased tissue a bit at a time. Sometimes the area can be quite large even without visible marks on the skin. Knowing this, it can be devastating to get the news that you need this procedure.

    For this reason, some people want a board-certified plastic surgeon to assist with the procedure. Unfortunately, most plastic surgeons are not trained in the Mohs procedure, however, Dr. Michael K. Kim does a lot of Mohs closure once the cancer is removed.

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    When Is Mohs Surgery Used

    Mohs Micrographic Surgery is most commonly used to remove non-melanoma skin cancers, like basal cell carcinoma and squamous cell carcinoma, or tumors where specific indications apply. MMS is designed to provide the highest cure rate of any form of skin cancer removal and at the same time limit the loss of unaffected tissue.

    It is for this reason that Mohs surgery is very highly utilized to remove skin cancers in the area of the head and neck, where preservation of the greatest amount of normal tissue, on critical anatomic areas , greatly improved the final esthetic outcome.

    Tumors removed by Mohs Surgery

    Indications for Mohs Surgery

    • Melanoma*
    • Merkel cell carcinoma
    • Cancers where the edge of the cancer is not easily seen
    • Previously treated tumors
    • Scar tissue exists in area of tumor
    • Tumors located at embryonic fusion planes
    • Tumors located in anatomic areas known to have a high incidence of recurrence
    • Basal cell carcinoma with aggressive Histologic character
      • Micronodular

    Treating Advanced Squamous Cell Cancers

    Lymph node dissection:Removing regional lymph nodes might be recommended for some squamous cell cancers that are very large or have grown deeply into the skin, as well as if the lymph nodes feel enlarged and/or hard. The removed lymph nodes are looked at under a microscope to see if they contain cancer cells. Sometimes, radiation therapy might be recommended after surgery.

    Immunotherapy: For advanced squamous cell cancers that cant be cured with surgery or radiation therapy, one option might be using an immunotherapy drug such as cemiplimab or pembrolizumab . However, these drugs havent been studied in people with weakened immune systems, such as people who take medicines for autoimmune diseases or who have had an organ transplant, so the balance between benefits and risks for these people isnt clear.

    Systemic chemotherapy and/or targeted therapy:Chemotherapy and targeted therapy drugs might be other options for patients with squamous cell cancer that has spread to lymph nodes or distant organs. These types of treatment might be combined or used separately.

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    What Are The Different Types Of Squamous Cell Carcinoma

    People assume there is just a single type of squamous cell carcinoma, but there are actually several different types. Some are more likely to spread than others, but in general, most types share similar characteristics. The primary difference between the following types is related to the unique characteristics of the cancerous cells.

    The primary types of squamous cell carcinoma are:

    • Adenoid/pseudoglandular squamous cell carcinoma
    • Small cell keratinizing squamous cell carcinoma
    • Spindle cell squamous cell carcinoma
    • Verrucous squamous cell carcinoma

    Electronic Skin Surface Brachytherapy

    Mayo Clinic Minute: How Mohs surgery is used to fight skin cancer

    Some skin cancers that do not require very deep radiation may be treated with a new form of radiation therapy applied directly to the skin, called electronic skin surface brachytherapy .

    In ESSB, we apply smooth, round disks to the skin these disks are attached to a radiation therapy machine. They are left in place for just a few minutes while the radiation is delivered, allowing the tumor to be treated. The approach spares underlying healthy skin from the effects of the radiation.

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    What Is The Difference Between Actinic Keratosis And Squamous Cell Carcinoma

    Actinic keratosis is a benign lesion, though it is considered premalignant. It is the precursor of squamous cell skin cancer. Once it grows, it has a 6-10% chance of turning into a full-blown tumor after 10 years. However, up to 25% of cases go away on their own within a year of minimizing UV exposure. That should give you plenty of time to keep it from becoming cancerous.

    Actinic keratoses are scaly, reddish, firm, raised skin patches with poorly defined borders. They may resemble other skin blemishes, but you can tell them apart by their sandpaper-like roughness. They can occur singly or in multiples in sun-exposed locations and are typically accompanied by other signs of UV damage.

    Tumors resulting from sun exposure are usually slow-growing. Meanwhile, highly aggressive types are frequently associated with other risk factors, such as a personal history of cancer and receiving chemotherapy, immunosuppression, chronic skin trauma, etc.

    Risk Factors for Cutaneous Squamous Cell Carcinoma
    Outdoor occupations

    Medical treatments like cancer chemotherapy and PUVA

    How Fast Do Squamous Cell Carcinomas Spread

    Squamous cell carcinomas typically spread slowly, and they have a low rate of metastasis . When caught in its early stages, a squamous cell carcinoma is highly curable, but approximately 2-6% of squamous cell carcinomas metastasize. Most of the time, these lesions only break down the skin and tissues where they have developed. However, if a squamous cell carcinoma presents in a high-risk locationsuch as on the lips, ears, genital region, or within a scaror has the chance to grow significantly larger and deeper, this can increase the chance of spreading. Those with suppressed immune systems are also at an increased risk of having their skin cancer spread.

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    Know That Surgery Sites Heal In Time

    Had basal cell on the side of my nose going toward the corner of my eye. Couldnt see anything on the skin, but thanks to the keen eye of my derm she saw it, and did a biopsy, and sent me to a Mohs specialist at UAB. He removed it along with surrounding tissue, sutured, sent me on my way looking, well, terrible! Within 1 year, the scare is completely gone & cant tell anything was done. Thankful for those yearly scans. Debbie

    I had Mohs done on a very small spot on side of nose right by eye. They had to put me to sleep and did a flap on forehead. Also had Mohs on lip. It went about 2 inches outside of mouth and about an inch in mouth. Great results. Almost unnoticeable. Joy

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