SKIN CANCER TREATMENT & MOHS SURGERY
Once skin cancer is identified by biopsy, treatment decisions are made based on the type of cancer found, and its appearance under the microscope. Two major treatment options are excision and Mohs surgery.
At Associated Dermatology, Skin Cancer surgeries are performed by Dr. Behlmer. Dr. Behlmer has 30 years of experience in skin cancer surgery, as well as 10 years of specialized training and experience as a Mohs surgeon. Dr. Behlmer maintains the following professional surgical affiliations:
- Fellow, American Society of Dermatologic Surgery
- Fellow, American Society for Mohs Surgery
- American Academy of Facial Plastic and Reconstructive Surgery
First the skin is made completely numb using local anesthetic. Visible cancer is removed with a margin of skin in an “ellipse” or football shape. Sutures are used to close the skin, often using deep stitches that absorb, as well as stitches on the top of the skin that need to be removed.
WHY REMOVE SKIN CANCERS WITH MOHS SURGERY?
Skin cancers may be larger under the microscope than they appear to the naked eye. These cancers may have “roots” in the skin or along blood vessels, nerves, or cartilage. Skin cancers that recur after previous treatments also may send out extensions deep under the scar tissue that has formed. Mohs surgery is specifically designed to remove these cancers by tracking and removing the cancerous “roots” or edges.
HOW IS MOHS SURGERY DONE?
There are three steps involved in Mohs surgery:
- First, the skin is made completely numb using a local anesthetic. The visible cancer is then removed with a thin layer of additional tissue. This takes only a few minutes and the specimen is taken to the lab for processing. A detailed diagram (a Mohs map) of the removed specimen is drawn.
- The specimen is color coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. These slices are placed on slides and stained for examination under the microscope. This is the most time consuming part of the procedure, often requiring an hour or more to complete.
- Finally, Dr. Behlmer carefully examines the slides under the microscope, which allows examination of the entire surgical margin of the removed tissue. That is, the entire undersurface and the complete edge of the specimen is examined. Any microscopic roots of the cancer can thus be precisely identified and pinpointed on the Mohs map.
- If more cancer is seen at the edges on the microscopic slides, Dr. Behlmer uses the Mohs map as a guide to remove additional tissue onlywhere cancer is present. This allows the Mohs surgery technique to leave the smallest possible surgical defect because no guess work is involved in deciding where to remove additional tissue. Only tissue around the “roots” and extensions of cancer is removed.