Services...Mohs Micrographic
Surgery
We at Dermatology Associates of Tyler specialize in the recognition
and treatment of skin malignancies including Mohs Micrographic surgery
performed by Dr. Lawrence L. Anderson, Dr. William Grabski, and
Dr. Shanna Meads, our fellowship trained Mohs surgeons. Tissue processing
is done in an adjacent specialty lab.
Mohs micrographic surgery is a highly specialized procedure for
the total removal of skin cancers under microscopic control. The
procedure is named in honor of the physician who first developed
this technique approximately 50 years ago, Dr. Frederick Mohs, Professor
of Surgery at the University of Wisconsin. Removal of certain types
of cancer under microscopic control results in the smallest possible
wound and highest rate of cure.
When is Mohs Microscopic Surgery Indicated?
Although the concept of Mohs micrographic surgery was developed
over 50 years ago, relatively few dermatologists were trained in
its use until recently. Only in the last few years has the technique
become widely available throughout the country. Mohs micrographic
surgery is now universally recognized as a precise method for treating
skin cancers. It is especially effective in cancers of the face
and other sensitive areas, because it can eliminate all the cancer
while causing minimal damage to the surrounding normal skin. Mohs
micrographic surgery is also ideal for the removal of recurrent
skin cancers – tumors that reappear after treatment and can
plague a patient repeatedly. While skin cancers are easily visible
to the patient, individual cancer cells are microscopic and any
cells left behind can cause the tumor to reappear. The tumor may
spread beyond its obvious external margins, with "nests"
of cell growing in unpredictable areas. With the Mohs technique,
all tumor nests can be identified and removed with a high degree
of accuracy, so that extremely high cure rates, as high as 95 percent,
are possible even when the cancer is recurrent. A dermatologist
is best trained to determine when this technique should be used
rather than the other effective procedures also available for treating
skin cancer.
What is Mohs Micrographic Surgery?
In Mohs surgery, multiple thin, horizontal layers of the cancer
are analyzed. Tumors may send tentacles of malignancy below the
surface, beyond the visible boundaries. The main differences between
micrographic surgery and other methods of removing skin lesions
is the microscopic control. The tumor is removed surgically with
a margin of presumed healthy tissue around and below the lesion.
The removed tumor is divided into segments, each of which is carefully
oriented on a "map." Each layer is carefully identified
and "mapped" by the surgeon so that its exact location
can be pinpointed on the wound. Every layer of tissue removed
is inspected under the microscope for evidence of cancer cells.
As long as cancer cells are seen anywhere within the specimen,
the surgeon continues to remove the tissue until no cancer cells
are present. Because each layer is examined microscopically, dermatologists
can be reasonably certain that the cancer has been eradicated
and that no tumor nests are left behind. In addition, only the
cancerous tissue is removed, saving as much normal skin as possible.
Before and After Mohs Surgery
Mohs micrographic surgery is commonly performed on an outpatient
basis with a local anesthetic administered to the area around
the tumor. Surgery usually begins early in the morning and is
finished the same day unless the tumor is extensive.
Because of the layer-by-layer removal, laboratory preparation
and examination under the microscope are delicate and require
great precision. They are also time consuming. If more than one
session is needed to remove all signs of a tumor, a dressing is
applied. Once the area is declared cancer-free, your surgeon will
discuss the options of wound healing or reconstructive surgery.
Periodic visits to your dermatologist are recommended to check
on your progress and spot any possible cancer recurrence as soon
as possible. Two of five patients with one skin cancer will develop
another within five years, so follow-up is extremely important
for early detection of any new lesions.
Rationale for Mohs Surgery
Cure rates for skin cancer after treatment with Mohs micrographic
surgery are as high as 95 percent. The technique produces the
smallest possible wound in the removal of any given tumor. The
smaller the wound, the greater the chances for a good cosmetic
result after the wound has completely healed. This is particularly
important on the face, where a good appearance after surgery is
of concern to the patient.
An overwhelming majority of tumors can be totally removed in one
treatment session, due to the preciseness of the surgery and microscopic
inspection. While the Mohs surgery is a technically demanding
procedure, it is also highly cost-effective, because fewer return
visits to the dermatologist’s office are needed for treatment
of a recurring lesion.
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Mohs Surgeons:
Dr.
Lawrence Anderson
Dr.
William Grabski
Dr. Shanna Meads
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