Skin cancer is the uncontrollable growth of abnormal cells in a layer of the skin. It attacks one out of every seven Americans each year, making it the most prevalent form of cancer. However, the majority of all skin cancers can be cured if detected and treated in time.

There are several different kinds of skin cancers, distinguished by the types of cells affected. The three most common forms of skin cancer are:

Basal Cell Carcinoma

Basal cell carcinoma usually appears as raised, translucent lumps. This cancer develops in 300,000 to 400,000 persons each year. Although the disease does not usually spread to other parts of the body through the blood stream, it may cause consider able damage by direct growth and invasion.

Squamous Cell Carcinoma

Squamous cell carcinoma is usually distinguished by raised reddish lumps or growths. This form of cancer develops in 80,000 to 100,000 persons per year. The disease can spread to other parts of the body. Approximately 2,000 deaths occur each year from this form of cancer.

Malignant Melanoma

Malignant melanoma typically first appears as a light brown to black irregularly shaped blemish. This serious form of cancer results in death if undetected and untreated. It can spread to other parts of the body through the bloodstream and the lymph drainage system.

 
Your dermatologic surgeon will select the most appropriate treatment for a particular skin cancer or precancerous condition from among the following procedures and techniques:

Curettage

Malignant tissue is scraped away with a sharp instrument. This method is most effective for small, superficial cancers that were not treated previously. It is often followed by destruction of the cancerous tissue with an electric needle.

Surgical Excision

Surgical excision, or cutting into the skin and removing the growth. The skin is then closed with stitches.

Cryosurgery

Liquid nitrogen is applied directly to the skin to freeze cancerous tissue.

Topical Chemotherapy

The application to the skin surface of chemicals capable of destroying precancerous growths.

MOHS Micrographic Surgery

About Mohs Surgery

 Mohs surgery has been shown to be a highly effective treatment for certain types of skin cancer, with a cure rate of up to 99% for certain tumors. Due to the fact that the Mohs procedure is micrographically controlled, it provides the most precise method for removal of the cancerous tissue, while sparing the greatest amount of healthy tissue. For this reason, Mohs surgery may result in a significantly smaller surgical defect and less noticeable scarring, as compared to other methods of skin cancer treatment. The Mohs procedure is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desirable for cosmetic and functional purposes. It may also be indicated for lesions that have recurred following prior treatment, or for lesions which have the greatest likelihood of recurrence. Dr. Echt has completed a two-year fellowship in Mohs Surgery sponsored by the American Society of Mohs Surgery. For more information click here.

History of Mohs Surgery

Early Events in the Development of the Mohs Technique

The Mohs surgical technique was developed in the 1930’s by Dr. Frederic Mohs, a general surgeon at the University of Wisconsin. This important development occurred while he was studying various injectable irritants to evaluate the in vivo inflammatory response in transplantable rat cancers and normal tissue. In the course of this study, Dr. Mohs noted that injected 20% zinc chloride solution inadvertently caused tissue necrosis in tumor and normal tissue. Further, he found that microscopic examination of this necrotic tissue showed well-preserved tumor and cell histology, the same as if the tissue had been excised and immersed in a fixative solution. This discovery formed the basis for a method by which cancers could be excised under complete microscopic control. This fixed tissue technique was utilized for over a decade, with Dr. Mohs being its pioneer, advocate, and lone practitioner. Long-term follow-up of his patients was carefully documented and gave further testimony to the effectiveness of this treatment. In 1953 a revolutionary breakthrough occurred while filming the removal of an eyelid carcinoma for educational purposes. An involved margin in the first level caused a delay in filming, this development necessitating utilization of horizontal frozen sections for the second and third levels. This fresh tissue technique worked so well that Dr. Mohs continued to use it for most eyelid cancers. He also found the technique useful for small and medium sized cancers at other sites, and subsequently continued to use the fresh tissue technique for multiple other skin cancers.

In 1969 Dr. Mohs reported the use of the fresh tissue technique for sixty-six basal cell carcinomas and for squamous cell carcinomas of the eyelid, with five-year cure rates of 100%. A corroborating series of data was instrumental in convincing the medical community of the validity of the fresh tissue technique, which had not yet largely replaced the fixed tissue technique. It is now well-established that the five-year cure rates using fresh tissue technique are equivalent to that of the fixed tissue technique. The fixed tissue technique is still recommended by some Mohs surgeons, however, for selected tumors.

Mohs Surgery’s Evolution as a Dermatologic Procedure

Dermatologists naturally gravitated to the Mohs technique and came to dominate the field, largely due to their training and expertise in skin cancer pathophysiology, cutaneous histopathophysiology, dermatologic surgery, and repair of complex defects. From the 1950’s to the 1970’s, Mohs surgical training was conducted on an informal basis. Training sessions lasted from several days to several months, and took place both in Dr. Mohs’ Chemosurgery Clinic and in the offices of physicians who had learned the technique firsthand from Dr. Mohs.

First Formal Organization of Mohs Surgeons

In 1967 the American College of Chemosurgery was formed, consisting primarily of dermatologists. By the 1970’s, several dermatology residency programs were beginning to provide training in Mohs surgery. In the 1980’s the American College of Chemosurgery began offering formal post-residency fellowships in Mohs surgery, and in 1986 officially changed its name to the American College of Mohs Micrographic Surgery and Cutaneous Oncology to reflect the predominance of the fresh tissue technique.

For more information on Mohs Surgery-- click here.

Malignant Melanoma

Laser Surgery Intense waves of light are beamed at cancerous skin to cut away or vaporize the tissue.