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Minimize scarring with gold standard skin cancer treatment

Published in Skin Care, Cancer Care, For the Health of It Author: Rachel Schuneman,MD Author: Rachel L. Schuneman, MD

When one of my patients has skin cancer on the head or neck, I recommend Mohs surgery as the preferred treatment option. This is the gold standard in skin cancer treatment for these locations. Mohs surgery was developed by a dermatologist and performed by dermatologists who have received training in this procedure.

There are many other skin cancer treatment choices including freezing (cryosurgery), scraping and burning, surgical removal (excision), radiation, topical chemotherapy and laser surgery. Unfortunately, these options have higher rates of recurrence and may be more disfiguring. Mohs surgery is the only treatment which offers up to a 99 percent cure rate while simultaneously minimizing the scar.

The goal of Mohs micrographic surgery is to remove the skin cancer, while doing minimal damage to surrounding healthy tissue. During this precise surgical technique, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains and margins are clear.

Mohs surgery is performed in an outpatient setting using a local anesthetic. Once the anesthetic has taken effect, your dermatologist uses a scalpel to remove the visible portion of the cancer along with a thin, underlying layer of tissue that’s slightly larger than the visible tumor.

A temporary bandage is placed on your incision while your tissue is taken to the laboratory for analysis. The margins of the skin specimen are inked with dye to orient the tissue. While you’re waiting, the tissue sample is frozen, cut into sections and examined under a microscope by the dermatologist.

If cancer remains, an additional layer of tissue will be removed from the affected area. Again, you’ll wait while the tissue is analyzed in the laboratory. So before leaving the clinic that day, you will know the skin cancer has been completely removed.

Once the skin cancer has been removed with negative margins, a skin closure is performed. Dermatologists are trained to perform simple closures as well as more complex skin closures including skin flaps and grafts.

Skin cancers treated with Mohs surgery

Mohs surgery is used to treat basal cell carcinoma and squamous cell carcinoma as well as some kinds of melanoma and other more unusual skin cancers.

Mohs surgery is especially useful for skin cancers that:

  • Have a high risk of recurrence or are already recurrent
  • Are located in areas where appearance and function are important
  • Have edges that are hard to define
  • Are large
  • Grow rapidly
  • Develop in immunosuppressed patients
  • Are aggressive in nature
  • Develop In patients who have genetic syndromes that have frequent and/or aggressive skin cancers

Once the skin cancer is cleared and the surgical site is closed, the area is bandaged and wound care instructions are given. You will have a follow-up visit with your dermatologist to monitor your recovery to make sure your wound is healing properly. You also will need subsequent visits to the dermatologist to monitor for skin cancer recurrence and any development of new skin cancers elsewhere.