Mohs Micrographic Surgery

Overview

Mohs Micrographic Surgery is the most advanced and effective treatment procedure for skin cancer available today. The procedure is performed by specially trained surgeons, Dr. Michael J. Crowe and Dr. Artis P. Truett III, who have completed at least one additional year of fellowship training (in addition to the physician's three-year dermatology residency) under the tutelage of a Mohs College member.

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.

Because the physician is specially trained in surgery, pathology, and reconstruction, Mohs surgery has the highest success rate of all treatments for skin cancer - up to 99 percent. The Mohs technique is also the treatment of choice for cancers of the face and other sensitive areas as it relies on the accuracy of a microscopic surgical procedure to trace the edges of the cancer and ensure complete removal of all tumors down to the roots during the initial surgery.

Effectiveness

Mohs Micrographic Surgery is an effective and precise method for treating basal cell and squamous cell skin cancers.

Clinical studies conducted at various national and international medical institutions - including the Mayo Clinic, the University of Miami School of Medicine and Royal Perth Hospital in Australia - demonstrate that Mohs surgery provides five-year cure rates exceed 99 percent for new cancers, and 95 percent for recurrent cancers. Mohs Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas.

Mohs Surgery may be appropriate when:

• the cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, fingers, toes, genitals;
• the cancer was treated previously and recurred;
• scar tissue exists in the area of the cancer;
• the cancer is large;
• the edges of the cancer cannot be clearly defined;
• the cancer is growing rapidly or uncontrollably.

The Procedure

Mohs surgery is an outpatient procedure performed in our Owensboro and Henderson locations in Kentucky. Typically, the surgery is completed the same day, depending on the extent of the tumor and the amount or reconstruction necessary. Local anesthesia is administered around the area of the tumor so the patient is awake during the entire procedure.  How it Works:

1. An injection numbs the area

2. The visibile portion of the skin cancer is removed.

3. A thin layer of tissue is excised from the surrounding skin and the base.

4. The removed tissue is mapped and sectioned, and microscopic slides are made.

5. Inder the microscope, the deep and peripheral margins are examined. If microscopic examination reveals the presence of additional skin cancer, it is located on the map.

6. The area(s) of remaining skin cancer is located on the wound, marked and removed. The entire process is repeaated until no skin cancer is found.

Reconstruction - Repairing the Wound

Doctors Crowe and Truett are also trained in reconstructive procedures and often will perform the necessary reconstruction to repair the wound.

As soon as the affected area is declared cancer-free, post-surgical options include:

• a small, simple wound may be allowed to heal on its own.
• a slightly larger wound may be closed with stitches.
• larger wounds may require a skin graft or a flap.

Post-Surgical Management

Post-surgical check-ups are recommended in order to monitor the patient's progress and spot any possible cancer recurrence in a timely manner. Since two of five patients with one skin cancer will develop another within five years, follow up is extremely important for early detection of any new lesions.