Mohs Micrographic Surgery
Specialized fellowship training is necessary to perform Mohs surgery. Dr. Perez finished her fellowship training with Dr. Perry Robins, the President of the Skin Cancer Foundation, at New York University in 1994. Dr. Perez now serves as a Vice President of the Skin Cancer Foundation. Dr. Perez has performed over 10, 000 of Mohs surgery during her career.
About Mohs Surgery
Mohs micrographic surgery is a safe and effective treatment for skin cancer that thoroughly excises the tumor while only mildly disturbing surrounding tissue. It is the only skin cancer treatment available that targets only cancerous tissue through comprehensive microscopic examination of the affected area.
Designed by Frederic E. Mohs, M.D., in the 1930s, Mohs Surgery excises not only the visible tumor but also any "roots" that may have extended beneath the surface of the skin. Five-year cure rates have been demonstrated up to 99 percent for first-treatment cancers and 95 percent for recurring cancers.
This procedure is most commonly used for the treatment of basal and squamous cell carcinomas, the two most common types of skin cancer. Mohs surgery is often recommended for recurring cancer because its results are so thorough. It is also ideal for treating cancer in cosmetically and functionally prominent areas such as the nose, eyelids, lips, hairline, hands, feet and genitals.
Mohs Surgery Procedure
Mohs surgery is performed on an outpatient basis in your doctor's office. It may be performed by a team of highly trained specialists who each focus on different parts of treatment, or one experienced Mohs surgeon well-equipped to perform the entire procedure. During the Mohs surgery procedure, the affected area is numbed with a local anesthetic. Small layers of skin are removed and then the area is closely examined to see if the cancer has been thoroughly eradicated. This process significantly reduces damage to surrounding tissue while effectively removing all traces of cancer.
Most Mohs procedures can be performed in three or less stages, which usually takes less than four hours to perform. Some cases may take longer, as there is no way of predicting the extent of cancer growth before treatment begins. Patients should arrange for someone to take them home following surgery.
Recovery and Results from Mohs Surgery
After Mohs surgery, patients may experience mild discomfort, bruising and swelling around the treated area. Prescription pain medication is available for patients if needed, although most only require Tylenol for pain relief.
There will be scarring after Mohs surgery once the area is healed, although the scars from this procedure are often smaller than those from other excision procedures. For patients concerned with the appearance of their skin after treatment, reconstructive procedures are available to reduce or even eliminate the appearance of the scar using skin flaps, skin grafts, collagen injections and more. These procedures may be performed at the same time as Mohs surgery or at a later date. Your surgeon may also utilize certain techniques to reduce visual scarring, including placing stitching in the skin's natural crevices or out-of-sight areas.
Compared to other skin cancer treatments, Mohs Surgery has a very high success rate. Basal cell carcinomas have a 97%-99% cure rate, while squamous cell carcinomas are cured 94%-95% percent of the time.
Risks of Mohs Surgery
Although Mohs surgery is considered safe for most patients, there are certain risks involved with any type of surgical procedure. Some of these risks may include numbness, muscle weakness, tenderness, itching, pain and failure of skin grafts. These risks are considered rare and, if they do occur, are usually mild and temporary. Patients can reduce the risk of complications by choosing an experienced Mohs surgeon to perform their treatment, and by following the surgeon's instructions after the procedure.
Full-Body Skin Exams
Full-body skin exams are an essential method of screening patients for benign or cancerous lesions that they may not have been able to see or recognize on their own. By using a dermatoscope and looking at all of your skin, Dr. Perez can often find potentially life-threatening growths in a timely manner. From head to toe and back to front, she inspects the skin for any suspicious growths. This quick and painless preventive measure is an invaluable tool in the early detection of skin cancer as well as many other dermatological conditions.
Excision of Benign and Malignant Tumors/Lesions
Soft-tissue tumors and tumor-like lesions develop in connective tissue as opposed to bone. Skeletal muscle, fat, tendons, fibrous tissue, and nerve and blood vessels (neurovascular) are all considered soft tissue. Surgical excision (removal) is usually sufficient for the treatment of benign (noncancerous) soft tissue tumors. Malignant (cancerous) soft tissue tumors, which are referred to as sarcomas, may require radiation therapy or chemotherapy in addition to surgery. In either case, the tumor is removed along with a margin of surrounding tissue to maximize the chances of eradicating all cancerous cells and preventing recurrence.
Excision of Malignant Melanomas
Malignant melanoma is the most serious skin cancer, the number one cause of death from skin disease. The origin of the tumor is melanocytes, the skin cells that produce melanin that impart color to our skin, hair and eyes. After establishing the diagnosis with a skin biopsy, the next step is establishing the disease severity by stage. There are four different stages of melanomas. Stage 0 is disease confined to the epidermis, the outer layer of the skin and totally curable by surgical excision of the tumor and 1 cm margins of normal skin. Stage 1 the tumor is still within the skin but has invaded the dermis to different levels of penetration. The thinner tumors invade the dermis not more than 1 mm down and curable in up to 91% of cases with surgical excision of the tumor and up to 2 cm of normal skin surrounding it down to fascia. Tumors whose thickness range from 1-4 mm, intermediate thickness melanomas, might be cure up to 87% with surgical excision, however more procedures as sentinel node tests might be needed in addition to resection. Tumors thicker than 4mm are thick melanomas and might have a different biological behavior and surgical excision of the tumor might need to be done in addition to sentinel node evaluation, lymph node resections and other additional therapies if metastatic disease is documented. Stage 3 describes patients with lymph node involvement and five year survival might be as low as 50%. Stage 4 include all patients with multiple organ involvement and survival depends on availability of tumor-targeted chemotherapy. Since early disease is curable by excision of the tumors then early diagnosis is the goal. Regular skin checks then save lives.