Treating the Most Common Skin Cancers: Mohs Surgery
Melanoma of the skin is the fifth most common cancer in the U.S., according to the National Cancer Institute, which estimates that more than 91,000 new skin cancer cases will be diagnosed in 2018. One of the most effective treatments for skin cancer is Mohs surgery, but a lot of people who might benefit from Mohs surgery don’t know what it is, even though the procedure dates back to the 1930s.
“Mohs is a micrographic surgical technique that uses a precise method of removing skin cancers while sparing surrounding healthy skin tissue. It offers the highest cure rate available for the most common skin cancer types,” says Nahid Y. Vidal, MD, the director of Dermatologic Surgery at Dartmouth-Hitchcock Medical Center and a member of the Dartmouth-Hitchcock's Norris Cotton Cancer Center's (NCCC's) melanoma/skin cancer program. “It is considered the most effective technique for treating many basal cell carcinomas and squamous cell carcinomas, the two most common types of skin cancer. Mohs surgery has up to a 99 percent cure rate for first time skin cancers, and about a 95 percent cure rate for recurrent or more aggressive skin cancers.”
Vidal explains that a Mohs procedure involves surgically removing skin cancer, layer by layer, and examining the tissue under a microscope until only cancer-free tissue is reached (so-called clear margins). These steps are repeated until the skin tissue is free of cancer. “Although it is variable based on the tumor type, and location of the tumor, most tumors require one to three rounds of surgery in the same day for complete removal,” she says. “Because the Mohs technique can spare skin and ensure complete removal, it is critical for skin cancers on areas such as the face.”
The surgery is usually done on an outpatient basis under local anesthesia and is performed in an operating room or procedure room that has a nearby laboratory. “This enables the surgeon to read the slides and conduct pathologic interpretation of the tissue margins in real time, and to correlate any findings with the surgical site on the patient,” Vidal says, adding that she performs Mohs surgery at D-H’s Heater Road location in Lebanon, NH. “Typically, surgery starts early in the morning and is completed the same day. On average, it may take three to four hours, but this depends on the extent of the tumor and the amount of reconstruction necessary.”
A board-certified dermatologist, Vidal also completed additional training in a Mohs fellowship program at the Mayo Clinic in Rochester, Minnesota following her dermatology residency. These one to two year fellowships in micrographic surgery and dermatologic oncology are accredited by the American College of Mohs Surgery (ACMS) and prepare Mohs surgeons to fill several roles. “The ACMS surgeon is specially trained as a cancer surgeon, a pathologist and a reconstructive surgeon,” Vidal says. “Fellowship-trained Mohs surgeons also have experience treating more complex cases of skin cancer, which sometimes require non-surgical management.”
Advantages of Mohs Surgery
According to Vidal, most patients require only one Mohs surgery for a tumor because of its high cure rate. The procedure is also cost-effective, she says, “because your surgeon is also evaluating the pathology and usually doing the reconstruction.” The other advantages of Mohs surgery include:
- Ensuring complete cancer removal during surgery, greatly reducing the chance of the cancer growing back
- Minimizing the amount of healthy tissue removed
- Maximizing the functional and cosmetic outcome resulting from surgery
- In most cases, repairing the site of the cancer the same day the cancer is removed
- Removing skin cancer when other methods have failed
Vidal adds that not every tumor needs Mohs surgery and surgery is occasionally not the right answer, “but your Mohs surgeon can work with you to explain options and the pros of cons of those options.”
Mohs surgery is available at D-H locations in Lebanon, Manchester and Keene. To learn more, please visit this website.