History
Developed by Frederic 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 chemo surgical technique. Over the course of a number
of days, thin layers of tissue were excised and frozen before
being pathologically examined. 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 layers of tissue and examine the fresh
tissue immediately. The normal treatment time has now been reduced
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 part of the Mohs micrographic surgery.
Clinical studies have shown that the cure rate for Mohs micrographic
surgery is the highest of all treatments for skin cancer --
up to 99 percent, even if other forms of treatment have failed
-- and 95 percent even if the skin cancer has been previously
treated. It relies on the accuracy of a microscope to trace
and ensure removal of skin cancer down to its roots. This procedure
allows dermatologists, trained in Mohs surgery, to see beyond
the visible disease, and to precisely identify and remove the
entire tumor, leaving healthy tissue intact unharmed. Mohs surgery
is most often used in treating two of the most common forms
of skin cancer: basal cell carcinoma and squamous cell carcinoma.
Indications:
Because the precise mapping procedure requires more time and
expertise than a standard excision, it is not performed on all
skin cancers. Your doctor may recommend Mohs micrographic surgery
if your cancer is recurrent, large or located on a cosmetically
delicate area such as your face such as the nose, ear, lips,
and eyelids where it is critical to limit the amount of tissue
removed for the best cosmetic result. The technique is also
used for tumors with poorly defined borders and ‘roots’
that invade surrounding tissue. Mohs surgery is indicated when:
- The cancer was treated previously and recurred
- scar tissue exists in the area of the cancer
- the cancer is in a difficult area where it is important
to preserve healthy tissue for maximum functional and cosmetic
result, such as eyelids, nose, ears, lips
- the cancer is large
- the edges of the cancer cannot be clearly
defined
- the cancer grows rapidly or uncontrollably
Procedure This procedure is a state-of-the-art treatment in
which the physician serves as surgeon, pathologist and reconstructive
surgeon. Once the visible tumor is removed, Mohs surgeons trace
the paths of the tumor using two key tools:
- A map of the surgical site
- a microscope
The steps of the Mohs procedure are summarized below:
Each stage of excision and examination can take up
to 30 minutes depending on the size of the tumor. Large skin
cancers will require longer processing time than smaller ones.
Reconstruction
The best method of managing the wound resulting from surgery
is determined after the cancer is completely removed. When
the final defect is known, management is individualized to
achieve the best results and to preserve functional capabilities
and maximize aesthetics. The Mohs surgeon is also trained
in reconstructive procedures and usually 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. If a
tumor is larger than initially anticipated, another surgical
specialist with unique skills may complete the reconstruction.
Dr. Humphreys is able to reconstruct most wounds with excellent
cosmetic results and restore the appearance of the treated
site. The photo gallery shows actual
patients with skin cancer treated by Dr. Humphreys using Mohs
micrographic surgery and reconstructive techniques.
The Mohs Surgeon
The surgeons that perform Mohs micrographic surgery are specially
trained dermatologists who also serve as pathologists and
reconstructive surgeons. The American College of Mohs Surgery and Cutaneous Oncology (ACMS or
Mohs College) is the sole professional organization
of physicians who have extensive training and experience in
Mohs micrographic surgery. To be accepted as members of the
Mohs College, physicians must complete a
residency in dermatology plus a one- or two-year fellowship
program approved by the Mohs College that
includes extensive training in pathology and reconstructive
surgery for a total of four to five years of specialized training.
Currently more than 50 training centers around the United
States are recognized by the College for instruction in Mohs
micrographic surgery.
Only physicians that have received special training in this
technique can produce the high cure rates associated with
Mohs micrographic surgery. While there is currently no required
board certification for Mohs surgeons, only physicians that
have completed a one year or longer fellowship program after
residency are approved by the American College of
Mohs Surgery and Cutaneous Oncology (ACMS).
The Mohs College should not be confused with
other organizations with similar names which do not have advanced
training requirements and have significantly different criteria
for membership. Only the ACMS requires extensive
monitored fellowship training and demonstration of competence
in the technique of Mohs micrographic surgery and reconstruction.
Dr. Humphreys is a full member of ACMS. For
additional information please visit the ACMS
website (www.mohscollege.org)
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