By Ashraf M. Hassanein, M.D., Ph.D –
More than two million Americans are diagnosed with skin cancer each year, and about one in five will develop a skin cancer in their lifetimes. Unfortunately, the number of new skin cancer cases is increasing at near epidemic rates and it is estimated that this upward climb will continue well into the foreseeable future. To make this even worse, is the fact that most skin cancers occur on the face, and can be very disfiguring. If you were to find yourself in this unfortunate but ever more common situation, how would you design the ideal skin cancer treatment? What would you do to save your face?
You would develop a technique that would do two very important things. First, it would remove the cancer. Second, the removal would involve the least amount of healthy tissue to ensure the smallest possible wound. Small wounds heal better than large wounds, and obviously the best wound is the one that has no cancer in it.
As it happens, Dr. Frederick Mohs came very close to achieving this ideal treatment in the 1930s. With a few refinements over the years by physicians who were able to adapt newer versions of the technique for use in a greater range of body sites. The Mohs micrographic surgical technique is now the most precise and effective way to treat skin cancer. This has resulted in the very rapid increase of its use for most types of skin cancer. Mohs surgery’s popularity is likely to keep increasing as the number of skin cancers continues to rise, and as more people become aware of the advantages. The type of cancers that most likely warrant Mohs surgery include those located in a cosmetically sensitive or functionally critical areas around the eyes, nose, lips, ears, scalp, fingers, toes, and genitals. Larger, aggressive, rapidly growing cancers are also candidates for Mohs surgery. Finally, recurrent cancers and those with ill-defined edges should be treated by Mohs surgery.
Localization is the ability to detect and determine the source of a sound. It’s a natural and sophisticated process that enables you to pinpoint the exact location of a bird twittering in the trees 100 yards away.
The brain is able to localize the sound because of this split second difference in the time it takes the sound to be processed. The hearing centers of the brain are able to pinpoint the location and source of the sound – and you hear that blue jay 300 feet away and can pick it out from the foliage that surrounds it.
Localization is an essential part of the listening experience. It warns us of danger. It points us in the direction of a distant caller or tells us which machine is running on the factory floor.
The ability to detect the source of a sound is something you use everyday, though you may not even realize it. It happens automatically – at least when both ears are operating at peak performance levels.
In fact, it may actually cause confusion and place you in danger because you think the car horn is coming from over there when, in fact, it’s coming from right behind you.
Today, Mohs surgery has come to be accepted as the single most effective technique for removing most Basal Cell Carcinoma and Squamous Cell Carcinoma (BCCs and SCCs), the two most common skin cancers. It accomplishes the nifty trick of sparing the greatest amount of healthy tissue while also most completely expunging cancer cells. Cure rates for BCC and SCC are an unparalleled 98-99 percent or higher with Mohs, significantly better than the rates for standard excision or any other accepted method. Thus, Mohs micrographic surgery is a state-of-the-art treatment for most skin cancer in which the physician serves as a surgeon, pathologist, and reconstructive surgeon.
The reason for the technique’s success is its simple elegance. Mohs differs from other techniques in that microscopic examination of all excised tissues occurs during rather than after the surgery, thereby eliminating the need to “estimate” how far out or deep the roots of the skin cancer go. This allows the Mohs surgeon to remove all of the cancer cells while sparing as much normal tissue as possible. The procedure entails removing one thin layer of tissue at a time; as each layer is removed, its margins are color coded, embedded in a special way and studied under a microscope for the presence of cancer cells. If the margins are cancer-free, the surgery is ended. If not, more tissue is removed from the margin where the cancer cells were found, and the procedure is repeated until all the margins of the final tissue sample examined are clear of cancer. In this way, Mohs surgery eliminates the guesswork in skin cancer removal, producing the best therapeutic and cosmetic results. The American College of Mohs Surgery (www.Mohscollege.org) is the prestigious college that trains qualified physicians in Mohs surgery. The Mohs College has accredited fellowship training programs that entails at least one year of intensive training.
In the past, Mohs was rarely chosen for Melanoma surgery for fear that some microscopic melanoma cells might be missed and end up spreading around the body (metastasizing). However, efforts to improve the Mohs surgeon’s ability to identify melanoma cells have led to special stains that highlight these cells, making them much easier to see under the microscope. Thus, more Mohs surgeons are now using this procedure with certain melanomas. With the rates for melanoma and other skin cancers continuing to skyrocket, Mohs will play an ever more important role in the coming decades.
Florida Dermatology Surgery
The Village: 352-430-2580