Mohs micrographic surgery, an advanced treatment procedure for skin cancer, offers the highest potential for recovery – even if the skin cancer has been previously treated. This procedure is state-of-the-art treatment in which the physician serves as surgeon, pathologist, and reconstructive surgeon. It relies on the accuracy of a microscope to trace and ensure removal of skin cancer down to its roots. This technique allows dermatologists trained in Mohs surgery to see beyond the visible disease and to precisely identify and remove the entire tumor, leaving healthy tissue unharmed. This procedure is most often used in treating two of the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma.
Developed by Frederick E. Mohs, M.D. in the 1930s, the Mohs micrographic surgical procedure has been refined and perfected for more than half a century. Initially, Dr. Mohs removed tumors with a chemosurgical technique. Thin layers of chemically fixed tissue were excised for pathological examination. He developed a unique technique of color-coding excised specimens and created a mapping process to accurately identify the location of remaining cancerous cells.
As the process evolved, surgeons refined the technique and now excise the tumor, remove stages of tissue which are color coded, mapped, frozen, sectioned, and immediately examined with the microscope by the physician. The chemosurgical technique developed by Dr. Mohs is no longer used.
This reduces the normal treatment time to one visit and allows for immediate reconstruction of the wound. The heart of the procedure—the color-coded mapping of excised specimens and their thorough microscopic examination—remains the definitive and unique part of the Mohs surgical procedure.
Clinical studies have shown that Mohs micrographic surgery has a five-year cure rate up to 99% in the treatment of skin cancer. By using detailed mapping techniques and complete microscopic control, Dr. Sundby can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The results are: (1) the removal of as little normal skin as possible, and (2) the highest possibility for curing the cancer. Using Mohs surgery, the percentage of cure is more than 99% for most skin cancers, even when other forms of treatment have failed. Other methods of treatment offer only a 50% chance of success if previous treatments have failed.
Common treatment procedures often prove ineffective because they rely on the human eye to determine the extent of the cancer. In an effort to preserve healthy tissue, too little tissue may be removed resulting in recurrence of the cancer. If the surgeon is overcautious, more healthy tissue than necessary may be removed causing excessive scarring.
Some tumors do not respond well to common treatments, including those greater than two centimeters in diameter, those in difficult locations, and tumors complicated by previous treatment. Removing a recurring skin cancer is more complicated because scar tissue makes it difficult to differentiate between cancerous and healthy tissue.
Mohs surgery is primarily used to treat basal cell carcinoma, squamous cell carcinoma, and melanoma but can be used to treat less common tumors.
Mohs Surgery is indicated when:
The Mohs process includes a specific sequence of surgery and pathological investigation. Mohs surgeons examine the removed tissue for evidence of extended cancer roots. Once the visible tumor is removed, Mohs surgeons trace the paths of the tumor using two key tools: a map of the excised tissue and a microscope.
Once the obvious tumor is removed, Mohs surgeons remove an additional, thin layer of tissue from the tumor site and create a “map” (or drawing) of the removed tissue to be used as a guide to the precise location of any remaining cancer cells. The surgeon also microscopically examines the removed tissue to check for evidence of remaining cancer cells.
If any of the sections contain cancer cells, Mohs surgeons return to the specific area of the residual tumor indicated by the map, remove another thin layer of tissue only from the specific area(s) where cancer cells were detected, or microscopically examine the newly removed tissue for additional cancer cells. If microscopic analysis still shows evidence of disease, the process continues, layer by layer until the cancer is completely gone. Selective removal of only diseased tissue using Mohs Surgery allows preservation of much of the surrounding normal tissue. This systematic microscopic search reveals the roots of the skin cancer which is why Mohs surgery offers the highest chance for complete removal of cancer while sparing the normal tissue. Cure rates exceed 99 percent for new cancers, and 95 percent for recurrent cancers.
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The best method of managing the wound resulting from surgery is determined after the cancer is completely removed. When the final defect is known, reconstruction is individualized to achieve the best results and to preserve function and maximize aesthetics. The Mohs surgeon is also trained in reconstructive procedures and often will perform the reconstructive procedure necessary to repair the wound. A small wound may be allowed to heal on its own, or the wound may be closed with stitches, a skin graft, or a flap. On occasion, another surgical specialist with unique skills may complete the reconstruction.
Besides it high cure rate, Mohs micrographic surgery also has shown to be cost effective. In a study of costs of various types of skin cancer removal, the Mohs process was found to be comparable when compared to the cost of other procedures, such as electrodesiccation and curettage, cryosurgery, excision, or radiation therapy. Mohs micrographic surgery preserves the maximum amount of normal skin which results in smaller scars. Repairs are more often simple and involve fewer complicated reconstructive procedures.
With its high cure rate, Mohs surgery minimizes the risk of recurrence and eliminates the additional costs of larger, more serious surgery for recurrent cancers. The Mohs procedure is performed in the surgeon’s office and pathological examinations are immediate. The entire process is usually completed in a single day.
By using detailed mapping techniques and complete microscopic control, Dr. Sundby Johnson can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The results are: (1) the removal of as little normal skin as possible, and (2) the highest possibility for curing the cancer. Using Mohs surgery, the percentage of cure is more than 99% for most skin cancers, even when other forms of treatment have failed. Other methods of treatment offer only a 50% chance of a success if previous treatments have failed. Other common treatments for skin cancer (including destroying tissue by scraping, burning, or liquid nitrogen; routine surgery; radiation; and chemical cream) offer lower cure rates and often results in larger wounds.
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Upon arrival at our office, you will be asked to verify or complete your medical history on our electronic medical record portal. Please bring your list of medications and illnesses. Please also plan to arrive at least 30 minutes before your scheduled appointment.
It may be necessary that you arrange to have a companion drive you to and from your surgical appointment because you may be given a mild sedative. You may also be more comfortable with someone to keep you company in the reception area.
The day of surgery, we suggest that you eat a normal breakfast unless otherwise specified.
Usually, one return visit is all that is needed to examine the healed surgical site or to remove your surgical dressings. Afterwards, you may return to your referring dermatologist for routine check-ups.
A follow-up period for the treated skin cancer is essential.
After having one skin cancer, statistics show you have a higher chance of developing a second skin cancer. You should have your skin checked by your referring dermatologist at least once a year not only to examine the treated skin cancer, but also to check for new skin cancers.
Please be sure to bring your current insurance card and photo identification with you each visit. We will need to keep a copy in your records.
You can check your insurance coverage by calling the phone number on the back of your insurance card to check participation status for Karen J. Sundby, M.D.
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ROSE FOUNDERS BUILDING
4700 Hale Parkway, Suite 140
Denver, CO 80220
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