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Hi, my name is Jessica Dorsey, and I am a board-certified dermatologist and fellowship-trained Mohs surgeon at U.S. Dermatology Partners and today I’m going to be talking to you a little bit about skin cancer.
Depending on the depth and type of the tumor there are a variety of ways that you can treat skin cancers. You can do something called electrodesiccation and curettage which is basically a scraping and burning of the skin cancer that has you know a little bit lesser cure rate than certain other treatments such as an excision where you take safety margins and then put sutures in after you remove the skin cancer. There's also Mohs micrographic surgery which is a specialized form of skin cancer removal where you take a layer of skin, process it while the patient is waiting and then you are able to take a look at 100% of the margin in order to know that you got the cancer out. Then for more complex skin cancers there is radiation therapy and then there are some oral or systemic medications that you can take. For some of the more simpler skin cancers there's topical treatments, if they're superficial you can freeze a skin cancer. So the best thing is to just discuss it with your doctor to figure out what the best treatment plan is for your specific type of cancer and location on the body.
Mohs surgery is typically recommended for more complex tumor types, larger tumors, recurrent skin cancers, and then those areas on the body where the tissue conservation is important such as the face, the nose, the lips, the ears, the scalp, the neck, the backs of the hands, the fingers, the fingernails. That’s typically where Mohs is recommended. The good news is Mohs surgery uses local anesthesia exactly where the skin cancer is sitting and once the numbness occurs the surgery itself is not painful. The other good news is that with Mohs surgery you're able to take smaller margins and so the surgery defect after you remove the cancer is a lot smaller and so therefore your scar is a lot smaller meaning that you're going to have an easier recovery time.
The benefits of Mohs surgery versus wide excision are that you're able to test the tissue while the patient is waiting so you know the day that you leave that the skin cancer is gone. That allows you to perform immediate reconstruction of the site which sometimes if it's a large or in a complex area such as the nose it may require a skin flap or a graft. The other benefit of Mohs surgery is that you're able to take a look at 100% of the tissue margin which allows for a higher cure rate and then it's a tissue sparing technique so whenever you take a narrow margin and you track the skin cancer exactly where it's headed you're able to go exactly where the skin cancer goes and leave normal tissue behind which means that you conserve tissue and make a smaller scar as a result.
So, the benefits of having a fellowship-trained Mohs surgeon are outside of residency they have had an additional one to two years of intense hands-on training at the direction of highly qualified physicians from multiple specialties not only Mohs surgery but also plastic surgery, oculoplastic surgery, ear, nose and throat surgery and surgical oncology among many others. If you have any questions regarding skin cancer, dermatologic surgery, Mohs surgery, or any other skin-related concern please reach out to the U.S. Dermatology Partners location nearest to you.