| SKIN CANCER SURGERY | PEER-REVIEW AN OVERVIEW each year in over two million people2
skyrocketing annually, focusing on the most effective types of treatment is of utmost importance. While there are multiple treatment options for different types of skin cancers, Mohs micrographic surgery (MMS) has proven itself a uniquely precise and beneficial procedure for the treatment of skin cancer that allows the surgeon to remove the totality of a tumour while preserving as much of the surrounding healthy tissue as possible.
O .
History of Mohs micrographic surgery This skin cancer treatment was first investigated in the early 1930s by Frederic Edward Mohs and was originally called ‘chemosurgery’. The MMS procedure was not truly developed until 1956, and it was not until the mid-1970s that it was more regularly used. When first introduced, many traditional dermatologists did not see its value, nor did they believe that dermatologists should be surgeons. A small group of physicians, including Drs Perry Robins, Alfred Kopf, and Hugh Brown, along with Dr Mohs, created the first Mohs team at New York University in 1965. This team fashioned the first dermatologic MMS fellowship programme in order to ensure that those physicians performing the procedure were skilled in the treatment3
The most common type of skin cancer is basal cell
carcinoma (BCC), with 2.8 million cases diagnosed every year in the US alone4
. Squamous cell carcinoma (SCC) is
VER THE LAST 30 YEARS, MORE people have been diagnosed with skin cancer than all other cancers combined1
.
Skin cancer is also the most common cancer in the United States with an excess of 3.5 million cases diagnosed . With these rates
treated with MMS.
Indications for Mohs According to the American College of Mohs Surgery, the indications for the use of Mohs are as follows: ■ The cancer is recurrent ■ Scar tissue exists in the area of the cancer or in sites of previous radiation therapy
■ The cancer is in an area where healthy tissue must be preserved for maximum functional and cosmetic results (i.e. the eyelids, nose, ears, lips, fingers, and genitals)
■ The cancer is large (>2 cm in diameter) or growing rapidly
■ The edges of the cancer cannot be clearly defined ■ The cancer grows rapidly or uncontrollably, including high risk SCC (infiltrative histology, poorly differentiated). Only one criterion is sufficient for indicating the use of
Mohs.
The procedure and its evolution Occasionally Mohs is used for melanoma in situ, but it is not preferred for use in thicker melanomas. Many surgeons prefer to do slow Mohs over a period of several days, using permanent paraffin slides rather than the frozen tissue method. With paraffin slides, the tissue is easy to stain and interpret in the case of pigmented melanoma cells. Basal cell and squamous cell carcinomas are easier to stain with haematoxylin and eosin (H&E) stains on frozen sections. The original technique of chemosurgery was called such due to the chemicals used during the procedure.
JENNIFER LINDER, MD, is a board-certified dermatologist, fellowship-trained Mohs skin cancer surgeon, biomedical engineer, and chemist. Linder Dermatology & Skin Cancer Center, Scottsdale AZ, US
email: info@linderdermatology. com
MOHS SURGERY
ABSTRACT Mohs micrographic surgery has proven itself the standard of care for specific skin cancer tumour removal. It was not always so. An overview of the history of this targeted procedure as well as its technique and indications help elucidate the features that set it apart from other excision methods.
the second most common with over 700000 US cases a year4,5
. These two types of cancers are the most commonly
KEYWORDS Mohs Surgery, Skin cancer, Mohs micrographic surgery, basal cell carcinoma, Squamous cell carcinoma, UV radiation
prime-journal.com | January/February 2015 ❚ 21
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64