When Is Mohs Surgery Appropriate
Most Mohs patients have a common type of skin cancer like basal cell carcinoma or squamous cell carcinoma . It’s usually recommended when the skin cancer is aggressive or large, appears in an area with little tissue beneath it, or it has been treated in the past and come back.
No matter what type of skin cancer you have, Mohs is only recommended for certain patients. You must have one skin cancer or a few skin cancers that are very close together.
Occasionally, doctors will recommend Mohs surgery 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.
Surgical Procedures For Basal & Squamous Cell Skin Cancers
Basal or squamous cell skin cancers may need to be removed with procedures such as electrodessication and curettage, surgical excision, or Mohs surgery, with possible reconstruction of the skin and surrounding tissue.
Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue. They may also recommend additional treatments for advanced squamous cell cancer, such as medications or radiation therapyenergy beams that penetrate the skin, killing cancer cells in the body.
Basal cell cancer is less likely to become aggressive, but if it does, our doctors may use surgery and other therapies to treat it.
How Does Squamous Cell Skin Cancer Develop
A huge majority of cutaneous squamous cell carcinoma cases result from chronic UV exposure. UV radiation mutates the DNA, damaging the skin and causing premature wrinkles, unwanted pigment, spider veins and actinic keratoses. Cancer develops with continued exposure. Melanin protects from UV damage, so individuals with skin of color are less vulnerable.
Early detection is crucial to successful treatment. But how do you know if people you care about have the beginnings of this condition? The easiest way is to do a self-skin check.
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What Are The Stages Of Squamous Cell Carcinoma
There are five stages of this form of skin cancer:
Most squamous cell carcinomas show up as Stage 0 or Stage 1.
- Stage 0 Also known as carcinoma in situ, this stage is not considered to be invasive. The abnormal cells are only in the upper layer of the epidermis, the outer skin.
- Stage 1 and Stage 2 Designation in these stages depends on how big the cancer is and if there are any high-risk features in the tumor.
- Stage 3 This stage has spread to areas below the skin, such as into the lymph nodes or other local structures like muscle, bone, or cartilage.
- Stage 4 The cancer has spread to distant sites in this stage.
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.
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What Can I Expect During Treatment
On the day of your surgery, youll want to avoid wearing makeup. And because youll be waiting while the layers of skin are evaluated, its a good idea to keep your schedule fairly clear so that youve got plenty of time. Some patients even bring a book or some other form of reading material for those waiting periods. When it comes to the actual surgery, most patients are surprised at just how easy it is. The surgery site will be numb, so youll feel no discomfort during the procedure.
What Is A Complex Repair
There are many way to stitch a wound closed. Most wounds are stitched as a straight line, AKA linear repair. However, there are different ways or techniques to pull the skin edges together. We most often classify linear repairs into one of 3 categories:
1. “Simple Repair” – A single layer of stitches are used to pull the layers of skin together.
2. “Intermediate Repair” – At least two layers of closure are performed to pull the skin together. A small amount of “undermining” of the skin edges may also be performed.
3. “Complex Repair” – At least two layers of closure are performed to pull the skin together. More significant “undermining” of the skin edges is performed.
What is “undermining”? Skin is attached to the underlying layers by small fibers. Undermining releases these fibers and allows the skin to slide together more easily. Typically a small surgical blade or surgical scissors are used to release these fibers
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How Do Doctors Diagnose Squamous Cell Carcinoma
The team at Ali Hendi, MD, includes skin cancer specialists who know how to identify squamous cell carcinoma. They begin by carefully examining your skin for signs of skin cancer.
If they see a spot that could be a squamous cell carcinoma, they take a biopsy of the growth. A biopsy involves numbing the area and then surgically removing all or part of it. Biopsying your skin is the only way to know for sure whether you have squamous cell carcinoma or not.
This biopsied tissue undergoes an examination under a high-powered microscope. This examination tells your provider whether you have skin cancer. If you have squamous cell carcinoma, they discuss appropriate treatments for your condition.
How Can I Spot Skin Cancer
Skin cancer tumors in their early stages often appear as flat or raised spots that are pale, pink, or pearly in nature. In some cases, pre-cancerous lesions may be flesh-colored but scaly in appearance. Basal cell cancers are also prone to bleeding.
A change in the appearance of a mole is also a skin cancer warning sign. If youre worried about an area of skin, its a good idea to have it evaluated by a dermatologist mohs surgery, who will conduct a visual examination and possibly a biopsy of the site. Avoiding tanning beds and sunburns are key to preventing skin cancer in the first place, as are routing screenings of your skin by a physician.
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The Single Most Effective Skin Cancer Treatment
It is almost inconceivable how much the treatment of skin cancers has changed in the past 50 years. In the mid-1960s when I was establishing my career in dermatology at New York University, we essentially had only three modes of treatment: curettage and electrodesiccation standard surgical excision of the tumor, and radiation. The cure rate for these techniques was about 90 percent when removing primary tumors, and only about 50 percent or lower when treating tumors that recurred after the initial treatment.
Today, a far greater variety of therapies exist, from topical medications and cryosurgery to lasers. However, one technique that came of age in the late 60s and 70s stands out above the rest: Mohs surgery is currently the most precise, tissue-sparing method for the treatment of basal cell and squamous cell carcinomas, the most common cancers in the United States.1 The goal of Mohs surgery is complete tumor removal with maximum preservation of healthy tissue. Cure rates are up to 99 percent for primary lesions, and an astonishing 94 percent for recurrences unsuccessfully treated by other methods impressive results for a technique that was barely known in the medical community half a century ago and aroused outrage when first announced as a skin cancer cure.
Waiting Too Long For Mohs Surgery
I have just been diagnosed with squamous cell carcinoma on my scalp. The best Mohs Surgery plastic surgeon in my area can’t see me until October 2. I am extremely anxious about waiting so long. I am very worried about how I might look afterwards if it is more extensive than I know. I am a middle-aged professional woman. I have fine, thin hair but looks nice so far. But I don’t think I have much hair to spare. Should I get a consultation from him and would it help ease my mind? Thanks!
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Squamous Cell Carcinoma Detection Diagnosis And Treatment At The Center For Surgical Dermatology
At the Center for Surgical Dermatology, our exceptional board-certified dermatologists specialize in detecting, diagnosing, and treating squamous cell carcinoma, as well as basal cell carcinoma, melanoma skin cancer, and the precancer, actinic keratosis.
To learn more about how we treat skin cancer and other skin conditions, reach out to our clinic in Westerville, OH!
Center for Surgical Dermatology is the largest medical and surgical skin treatment and wellness facility in Central Ohio. Since 2007, our board-certified dermatologists, fellowship-trained Mohs surgeons, and caring professional staff have provided patients with treatment they can trust in an environment second to none. Learn more about our state-of-the-art Dermatology Center before booking your appointment today.
Choosing A Treatment For Squamous Cell Carcinoma
Squamous cell carcinoma treatment often involves outpatient surgery, which you are encouraged to learn about. Some common options offered at Moffitt Cancer Center include:
- Mohs surgery Offered in conjunction with the USF Department of Dermatology, Mohs surgery is generally regarded as the gold standard of treatment for squamous cell carcinoma, and is performed in stages during one office visit. A surgeon removes a thin layer of tissue, which is examined by a pathologist in an on-site lab. If cancer is detected, the surgeon will remove another thin layer of tissue, and the process will be repeated until no cancerous cells are found.
- Excisional surgery Using a scalpel, a surgeon removes a cancerous lesion along with a small margin of surrounding healthy tissue. The tissue will be sent to a lab, where a pathologist will examine it to confirm that all cancerous cells have been removed. If cancer is detected in the safety margin, the patient may need to return for another surgery.
- Electrosurgery Using a curette, a physician scrapes away a lesion, then heats the treated area with an electrocautery needle to control bleeding and destroy any residual cancer cells.
In addition to your cancers stage, your physician will consider the size and location of your tumor, as well as your personal preferences and general health, before recommending an appropriate treatment procedure for you.
The Gold Standard Skin Cancer Treatment
Mohs micrographic surgery, most commonly called Mohs surgery, has the highest cure rate with the lowest chances of regrowth, in some cases < 1%, for common types of skin cancer, including basal cell carcinomas and squamous cell carcinomas. The small margins obtained in Mohs surgery provides the added benefit of sparing more of your healthy tissue than a standard excision.
This precise surgery is used to treat skin cancer, or cutaneous oncology, by removing and examining thin layers of cancerous skin cells repeatedly until only cancer-free tissue remains. On average, your surgeon will perform this process two to three times until the cancerous cells are completely removed. This multi-step procedure is completed all in the same day at the same appointment, and ensures that all of the cancer cells have been removed before the surgeon reconstructs the wound and you are sent home.
Mohs surgery is considered the gold standard of certain skin cancer surgery treatments because it has the highest cure rate and saves the greatest amount of healthy skin, while also leaving the smallest scar possible for basal cell carcinoma treatment or squamous cell carcinoma treatment.
Comparison To Other Modalities Of Treatment
Mohs surgery is not suitable for all skin cancers.
Mohs micrographic surgery is the most reliable form of margin control utilising a unique frozen section histology processing technique – allowing for the complete examination of 100% of the surgical margin. The method is unique in that it is a simple way to handle soft, hard-to-cut tissue. It is superior to serial bread loafing at a 0.1 mm interval for improved false negative error rate, requiring less time, tissue handling, and fewer glass slides mounted.
The clinical quotes for cure rate of Mohs surgery are from 97% to 99.8% after 5 years for newly diagnosed basal-cell cancer , decreasing to 94% or less for recurrent basal-cell cancer. Radiation oncologists quote cure rates from 90 to 95% for BCCs less than 1 or 2 cm, and 85 to 90% for BCCs larger than 1 or 2 cm. The Surgical excision cure rate varies from 90 to 95% for wide margins and small tumors, to as low as 70% for narrow margins and large tumors.
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How This Affects Carcinomas
What is interesting about basal cell carcinomas versus squamous cell carcinomas is that, while the squamous cells are located on the outermost layer of the epidermis, these cancers have the potential to grow deeper into the skin. Basal cell cancers rarely do so. Patients should be educated about what to look for during skin cancer self-exams to help them identify potential squamous cell carcinomas.
Typical characteristics of SCCs include:
- An open or recurring sore that alternates between bleeding and crusting.
- Elevated growths with a depressed center .
- Wart-like growths that occasionally crust or bleed.
- Scaly patches of red skin with irregular edges.
Skin Grafting And Reconstructive Surgery
After surgery to remove a large basal or squamous cell skin cancer, it may not be possible to stretch the nearby skin enough to stitch the edges of the wound together. In these cases, healthy skin can be taken from another part of the body and grafted over the wound to help it heal and to restore the appearance of the affected area. Other reconstructive surgical procedures, such as moving ‘flaps’ of nearby skin over the wound, can also be helpful in some cases.
What Is The Purpose Of Mohs Surgery
Mohs surgery is a painstaking procedure. It requires microscopic analysis of tissue cells while the surgery is taking place. The borders of each thin layer of tissue are analyzed for potential malignancy as they are removed horizontally. This technique is designed to remove the entire tumor with minimal amounts of healthy tissue. This results in less disfigurement. For this reason, Mohs surgery is ideal for removing skin cancers from the face, ears, or genitals.
The procedure is highly effective for skin cancers that have high rates of recurrence. Its also effective on aggressive or large lesions. Mohs surgery is also used when lesions have ill-defined borders.
What Is Mohs Micrographic Surgery
Mohs micrographic surgery, or Mohs surgery, is a precise surgical technique in which the complete excision of skin cancer is checked by microscopic margin control. It offers the highest cure rates while maximizing preservation of healthy tissue. The principles behind it were developed by Dr Frederic Mohs in the 1930s.
Mohs surgery is recognised as the treatment of choice for high risk basal cell carcinoma and squamous cell carcinoma. The skin cancer is progressively removed in stages. After each stage, the excision margins are microscopically examined for remaining cancer cells and this process is repeated until all cancer has been removed.
Mohs is a form of complete circumferentialperipheral and deep margin assessment .
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Mohs Micrographic Surgery Effective In High
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Mohs micrographic surgery showed continued efficacy in preventing local recurrence and progression in high-risk cutaneous squamous cell carcinoma, according to a study.
There is limited literature on the long-term outcomes and prognostic factors of high-risk cutaneous squamous cell carcinomas treated with Mohs micrographic surgery,Andrew Matsumoto, MD, of the department of dermatology at the University of Texas Southwestern Medical Center in Dallas, and colleagues wrote.
In the current single institution, retrospective cohort analysis, the researchers aimed to assess rates of local recurrence, metastatic disease and disease-specific mortality in 882 patients treated with Mohs surgery. Eligible participants had been treated with the Mohs procedure alone or with adjuvant therapy.
Patient and tumor-related factors with poor outcomes also underwent analysis.
The final analysis included 842 patients treated with Mohs micrographic surgery alone. These patients were followed for a median duration of 2.4 years.
The overall local recurrence rate for the full cohort was 2.5%. Metastatic disease occurred in 1.9%, while the disease-specific mortality rate was 0.57%.
remains an effective treatment for , the researchers wrote. Current staging systems may be limited by inconsistent inclusion of poor differentiation.
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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