Removing cancer one slice at a time
Basal cell and squamous cell skin cancers are the most common types among all cancers in the United States, according to the American Cancer Society. Both cancers form in the outermost part of the skin called the epidermis and often occur from exposure to ultraviolet (UV) from the sun or indoor tanning.
A friend of mine, Jan Foster of Falmouth, was recently diagnosed with squamous cell skin cancer and had Mohs surgery with Kevin Moore, MD, MPH, a dermatologist and Mohs surgeon with Contemporary Dermatology in Marstons Mills.
“I can’t believe how well the procedure went and now, a couple of weeks later, there is hardly any scar, and I don’t have to worry that I have cancer,” said Foster.
Mohs surgery has a history of development that began in the 1930s with Frederick Mohs, MD, Dr. Moore explained.
“Dr. Mohs would typically cut out a skin cancer and at the time, it would take weeks to have it analyzed and get results,” he said. “At that time, they used different chemical stains to check the margins for the absence of cancer cells, and if there were none, it meant all the cancer had been removed. Dr. Mohs decided the process needed to be changed and created a chemical stain that could determine clear margins within hours. Today, the rapid stain can give us results in 45 minutes to one hour.”
The Steps in Mohs Surgery
In Mohs surgery, the tumor is removed one slice at a time.
“I liken it to flattening a Reese’s Peanut cup with the wrapper still around it so I can see all the edges that are attached to the rest of the peanut butter cup, instead of just one select area of the top of the candy,” Dr. Moore said. “This way I can see the entire area of the cancer, so I don’t miss anything.”
Once Dr. Moore removes the skin cancer, the patient remains in the procedure room while they await the results of the staining process of the biopsy. The tissue sample is stained in a clock pattern, at 12, 3, 6, and 9 o’clock and, if for example, there is still cancer at 6 o’clock, he knows to go back and remove more skin from that area only. Once the staining shows all the margins are clear, Dr. Moore will close the area where he removed cancer and stitch it up. If the margins are clear with the first stain, the entire process takes less than two hours. It will be longer if he needs to remove more skin.
The Advantages of Mohs Surgery
The advantages of Mohs surgery, according to Dr. Moore are the following:
- Mohs surgery has a 99 percent cure rate.
- Patients come into the office on the day of surgery, and they leave knowing their cancer is completely gone.
- Sedation is not necessary, and the skin is numbed using a local anesthetic.
- Mohs surgery is very precise, and the least amount of skin is removed.
- Pain is treated with Tylenol and by applying an ice pack.
- Mohs surgery is done in cosmetically sensitive areas of the face, head, neck or areas that have functional or tight skin like the shins, feet and hands.
- Topical stitches are removed in two weeks and the stitches under the skin dissolve over time. Patients apply a silicone strip to the area after the stitches are removed to give extra support and help remodel the scar to make it as minimal as possible.
Foster has completely healed from her surgery.
“The entire process was explained so well to me prior to my surgery, that I wasn’t nervous at all,” said Foster. “The day of my surgery, Molly Oakes, MA, greeted me, and she went through what would happen during the first part of the procedure and held off telling me everything until after the biopsy results, so as not to overwhelm me. I really appreciated that consideration.”
Foster added a piece of advice for those who may be nervous about having the surgery.
“I would say go ahead and have the surgery even if you are nervous. It is minimally invasive and I never felt any pain through the entire process. Both Dr. Moore and Molly made me feel very at ease and comfortable.”
