Skin cancer is the most common of all cancers and accounts for nearly half of all cancers in the United States. More than 3.5 million cases of basal and squamous cell skin cancer are diagnosed in this country each year. Melanoma, the most serious type of skin cancer, will account for more than 76,600 cases of skin cancer in 2013.*

Early detection is key to saving lives. Annual complete body skin examinations by the doctors at Affiliated Dermatology can help in the diagnosis and treatment of skin cancer. Affiliated Dermatology also specializes in the treatment of malignant melanoma by using the specialized technique of Slow Mohs surgery. Slow Mohs represents a staged excision but in contrast to Mohs micrographic surgery, the margins are processed as rush permanent sections. We have successfully employed this technique for several years.

As the most advanced and effective treatment today, Mohs micrographic surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains.

The procedure is performed by specially trained surgeons who have completed at least one additional year of fellowship training (in addition to the physician’s three-year dermatology residency) under the guidance of Dr. Richard Averitte.

Not all skin cancers require Mohs surgery.  Affiliated Dermatology will determine if you are a candidate and require this procedure.  Mohs surgery is typically used for skin cancers in anatomic areas in which preservation of normal healthy tissue is critical for functional and/or cosmetic purposes, such as the face, neck, eyelids, nose, ears, fingers, and toes.  It can also be used for skin cancers that have recurred after being treated, large skin cancers on the body, and other types.  Studies have shown Mohs surgery to provide a 5-year cure rate of 99% for new cancers.

History of Mohs Surgery

Initially developed by Dr. Frederic E. Mohs, the Mohs procedure is a state-of-the-art treatment that has been continuously refined over 70 years. With the Mohs technique, physicians are able to see beyond the visible disease, to precisely identify and remove the entire tumor layer by layer while leaving the surrounding healthy tissue intact and unharmed. As the most exact and precise method of tumor removal, it minimizes the chance of re-growth and lessens the potential for scarring or disfigurement.

Benefits of Mohs Surgery

Mohs micrographic surgery is distinct from routine surgical excision. With the Mohs technique, Affiliated Dermatology surgically removes the tumor and carefully maps, color-codes, and thoroughly examines the tissue microscopically on the same day of surgery. During this process, the surgeon evaluates 100% of the tissue margin to ensure that the tumor is completely removed prior to repair of the skin defect. Mohs micrographic surgery therefore results in the highest cure rate for complex skin cancers, up to 99%, while minimizing the removal of normal tissue.

 

The Procedure

The Mohs surgical process involves a repeated series of surgical excisions followed by microscopic examination of the tissue to assess if any tumor cells remain. Some tumors that appear small on clinical exam may have extensive invasion underneath normal appearing skin, resulting in a larger surgical defect than would be expected. It is therefore impossible to predict a final size until all surgery is complete. As Affiliated Dermatology utilizes Mohs surgery to treat complex skin cancers, approximately half of all treated tumors require 2 or more stages for complete excision.

Doctors at Affiliated Dermatology have received extensive training in Mohs surgery.  Residency training provides the basic skill set for the Mohs technique, including skin cancer pathology, dermatopathology, dermatologic surgery, the repair of surgical defects, and training under other Mohs surgeons. Prospective patients may wish to learn more about Mohs surgery.  If you have been diagnosed with a skin cancer for which Mohs surgery is indicated, we would be happy to discuss the procedure with you in further detail.  Please click here to book a consultation with Affiliated Dermatolgy.

Slow Mohs Surgery

Slow Mohs is a very useful technique for histologically subtle neoplasms that may be difficult to recognize on frozen sections that are used in the regular Mohs procedure.

Some tumor cell types, including melanocytes, lose their cellular details when processed as frozen tissue used in traditional Mohs surgery. In order to accurately and adequately evaluate excised tissue margins of thin melanomas, a leading-edge, modified Mohs surgery technique called “slow Mohs” was developed. It utilizes permanent sections for tissue evaluation. This procedure allows for microscopic evaluation of the entire surgical margin.

The entire underside and edges of the tissue are examined thoroughly to ensure there are no remaining skin cancer cells.  If cancer is still present, another layer of tissue is removed, but only at the exact site that was noted to be “positive.”  This allows any normal, non-involved skin to be preserved.  Once the skin cancer has been removed, the surgical defect is then repaired, most often by the dermatologist.  In some cases, other specialists will be involved in the repair, including plastic surgery, ENT Surgeons, or others.

Any residual tumor seen is removed by repeating the “slow Mohs” procedure. After complete removal of the melanoma cells, reconstructive surgery is completed with maximal preservation. The visible portion of the skin cancer is removed by the Mohs surgeon, along with a narrow margin of surrounding normal skin.  The tissue is then taken to an on-site lab, where it is processed, stained, and evaluated under the microscope by the surgeon.

With an in-house laboratory and board-certified dermatopathologist, the doctors at Affiliated Dermatology are able to provide this new state- of-the-art treatment for thin melanomas.


Whether you wish to receive testing or treatment for a skin condition, you can be assured that you will be treated with professional and personal care by one of our skin care experts. Please feel free to call us at (480) 556-0446 or use the form below to leave us a message.