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Skin Cancer and Mohs Micrographic Surgery



SKIN CANCER

Most skin cancers are caused by accumulated sun (ultraviolet) exposure over many years. Approximately half of your lifetime exposure occurs by age 18. Therefore protection with sunscreens with an SPF of at least 15 should begin during infancy. Just growing up in Southern California with average daily sun exposure, even without sunbathing, can result in skin cancer in fair complexioned people. Your dermatologist can discuss other protective measures with you.

There are about 1 million new cases of skin cancer every year. The most common types are basal cell carcinoma and squamous cell carcinoma with basal cell carcinoma occurring about 4 times more often. Although these two types rarely spread to other parts of the body, if left untreated, they can penetrate and destroy skin, muscle and bone as well as adjacent structures such as the eyes, lips, nose and ears. The sooner that basal cell and squamous cell carcinomas are detected and treated, the earlier they might be cured and the smaller the resultant scar.

See your dermatologist for any growths on your skin that bleed, grow or change color or any sores or rashes that do not heal.



TREATMENT

There are several accepted methods for treating skin cancers which include:

  • Curettage and electrodesiccation-the softer skin cancer is scraped away from the surrounding firmer healthy skin and the remaining tissue is burned to stop bleeding and eliminate residual skin cancer cells
  • Surgical Excision-removal by scalpel
  • Cryosurgery-treatment by freezing with liquid nitrogen
  • Fluorouracil (Efudex, Fluoroplex) cream-some superficial skin cancers may be treated with a cream
  • Radiation treatment
  • Mohs Micrographic Surgery

Your dermatologist will explain the various treatment options and which would be best for your skin cancer.



MOHS MICROGRAPHIC SURGERY

Mohs Micrographic Surgery (MMS) is one of several techniques available to treat skin cancer. This technique allows removal of the skin cancer while leaving as much healthy skin as possible, therefore leaving the smallest possible scar. It has the highest cure rate, but is also one of the most difficult to perform. Therefore it is used for special circumstances:

  • Aggressive skin cancers
  • Skin cancers that reappear after previous treatment
  • Skin cancers that occur in areas where it is important to preserve as much healthy skin as possible (e.g., eyelids, nose, lips and ears)
  • Large skin cancers
  • Skin cancers whose borders are hard to see

 

MMS  TECHNIQUE

  1. The involved area is anesthetized with a very small needle.
  2. The visible portion of the tumor is removed.
  3. A thin layer of surrounding skin is removed and carefully color coded with dyes and a corresponding map is made.
  4. The removed skin is then examined under the microscope and any residual cancer cells are noted on the map.
  5. Additional thin layers of skin are removed and examined only from the locations indicated on the map.
  6. Steps 3 through 5 are repeated until all the cancer cells are removed.

This technique allows removal of the skin cancer while preserving as much of the healthy skin as possible. Since this leaves the smallest possible wound, it results in the smallest possible scar.

 

REPAIR

After the skin cancer has been removed using the Mohs technique, there are various options available to repair the wound. Which repair is chosen depends on the location and size of the wound and therefore can not be determined before the skin cancer is removed. These options include:

  • No repair: allowing the wound to heal by itself over a few weeks time
  • Direct closure: pulling the skin together with sutures
  • Flap: using loose, extra, adjacent skin to close the wound
  • Graft: taking skin from another location to close the wound.

Your Mohs surgeon will discuss the best options for your situation and then you will decide together the best choice for you.





Letter to Patients Referred to Our Office For Mohs Micrographic Surgery

Mohs Micrographic Surgery Instructions

Questions For Your Insurance Company


Northridge Dermatology Associates
David H. Friedman, M.D.
William R. Coleman, M.D.
9535 Reseda Blvd., #304
Northridge, CA 91324

1-818-886-3884