Skin Cancer | Mohs Micrographic Surgery
Skin cancer is a growing concern all over the world and does not discriminate with regard to age, ethnicity or gender.
A physician consult and/or referral to Board Certified Dermatologist, Dr. Muba Taher is required to diagnose suspicious lesions. Please make an appointment with your family physician and seek a referral to Dr. Muba Taher if required.
TYPES OF SKIN CANCER
Basal Cell is the most prevalent form of skin cancer. Largely the result of exposure to the sun, it appears as a blemish that refuses to heal – and can have a pearly or shiny texture. The area may be prone to recurrent bleeding. If left untreated it can affect the surrounding tissue, nerves, and blood vessels. Fortunately, Basal Cell Carcinoma rarely ever spreads to lymph nodes or other organs.
Squamous Cell Carcinoma is the second most common form of skin cancer, is also caused by prolonged exposure to the sun. Affected skin patches can appear dry and scaly. A small number of SCC can be aggressive and can spread to the lymph nodes and other internal organs.
Malignant Melanoma often appears as a non-uniform dark patch or a freckle of unusual colour, this is the most serious form of skin cancer. Fortunately, malignant Melanomas can be cured through surgery if diagnosed and treated at an early stage.
STATISTICS ON SKIN CANCER
In 2012, an estimated 5800 Canadians were diagnosed with Melanoma with an estimated rate of death of 970 individuals. The incidence of skin cancer continues to grow by an estimate of 1.4% per year.
SKIN CANCER PREVENTION
Don’t become a statistic! Regular skin checks, sunscreen and sun protection (ie: hats) are your best defense. Skin cancer is largely preventable – do your part!
Treatment options are available to help reduce and remove pre-cancerous lesions before they evolve into skin cancers.
Treatment options include:
- TCA Chemical Peel
- Metvix Cream/Red Light Pulse Dye
- Fraxel Laser
Ensure your sunscreen has a minimum protection rating of 30 SPF and UVA/UVB and/or Broad Spectrum on the label. For best results, re-apply every 2 hours.
Benign Nevus (Moles)
Most nevi or moles appear on the skin at a young age and are usually harmless (meaning non-cancerous). Benign nevi or moles are uniform in colour, such as black, brown, skin-colored; they are symmetric; either raised or flat. A nevus becomes concerning when one of these features change. To know if your mole is changing follow these simple guidelines: ABCDE
Cosmetic mole removal.
For those individuals who are concerned with the cosmetic appearance of a mole, Edmonton Dermatology can provide safe, effective treatment for removal. The removal is based on the type, appearance and location of the mole. Therefore our office requires a referral from a family physician for an appointment to see our dermatologist.
A combination of treatments can be used to remove skin tags including: liquid Nitrogen, medical scissors and/or electro-cautery procedure.
What Is Mohs Micrographic Surgery?
Mohs micrographic surgery is named after its inventor, the late Dr. Frederic Mohs from the University of Wisconsin. This technique was first developed in the 1930’s and has since evolved into a specialized procedure for the removal of skin cancers. It involves surgical excision of cancer containing tissue and microscopic examination of all cut surfaces that are correlated with a drawn map of the wound.
How Is It Performed?
This method involves five separate steps:
(1) Removal of the bulk of the cancer with a skin scraper (a curette).
(2) Surgical removal of a thin underlying layer of tissue.
(3) Drawing a map and preparing stained frozen tissue sections.
(4) Examination of the excised tissue under the microscope.
(5) After the tissue is removed, it is marked with two colored dyes to distinguish the two different skin edges. By doing this, we are able to pinpoint the exact location of any remaining tumor during the microscopic examination. If more cancer is found on the microscopic examination, its location is marked on the map, and the entire procedure (except step 1) is repeated, but only in the area of the remaining cancer.
How Long Does Mohs Micrographic Surgery Take?
Total removal of the skin cancer, which may involve several surgical stages, is usually completed in one day. After the surgery, a decision is made as to the best way to manage the wound created by the surgery.
How Effective Is Mohs Micrographic Surgery?
Using the Mohs micrographic surgical technique, the percentage of success is very high, often 95% to 98%, even if other forms of treatment have failed. Therefore, with this technique, an excellent chance of cure is achieved. However, no one can guarantee a 100% chance of cure.
What Are The Advantages Of Mohs Micrographic Surgery?
After the initial tissue is removed, the surgeon can pinpoint with the microscope the areas where there is cancer and selectively remove tissue only from those areas in the following surgical stages. In this way, the skin cancer is traced out to its roots with little guesswork involved, which results in:
(1) The removal of as little normal tissue as possible, and
(2) The highest chance of curing the patient.
What Are The Disadvantages?
Mohs micrographic surgery is performed under local anesthesia so there may be some discomfort from the injections. Also, since the process may involve several surgical stages, the time for this procedure may take several hours and often all day.
Will The Surgery Leave A Scar?
Yes. Most forms of therapy will leave a scar. However, the Mohs micrographic surgical procedure tends to minimize this as much as possible. After the wound is healed you may wish to have the scar improved. Generally, time alone will improve all scars. Any scar may be further touched up and improved with a variety of techniques, such as injections, sanding (dermabrasion), laser, or further surgery. Remember, all scars improve with time.
How do I prepare for Mohs Micrographic Surgery?
The best preparation for Mohs surgery is a good night’s rest followed by breakfast. In most cases, the surgery will be completed on an outpatient basis. Because you can expect to be here for most of the day, it is wise to bring a book or magazine to read. Also, because the day may prove to be quite tiring, it is advisable to have someone accompany you on the day of surgery to provide companionship and to drive you home.
Once you agree to have Mohs Micrographic surgery done, your surgeon will take a careful medical history and physical exam to identify special preparations that might be needed. For example, you may be asked to stop some of your blood thinners, or you might have to get medical clearance from some of your other doctors (such as your family doctor, internist, or cardiologist). Some patients need to take antibiotics prior to their surgery.
What Can I Expect After The Surgery Is Complete?
❑ Together with your doctor, a decision will be made about how and if your wound will be sutured.
❑ Either way, you will be given instructions on how to look after your wound which includes daily dressing changes.
❑ If sutures were used to close your wound, you will be told when to have them removed.
❑ You may be given a course of antibiotics to help prevent an infection.
❑ Medications may be given to help control discomfort after the procedure.
❑ We look forward to seeing you after your procedure for a routine checkup to make sure you have healed properly and that there are no signs of the cancer coming back.
Possible complications from Mohs surgery:
You may experience discomfort at the surgery site. Due to its potential to cause bleeding, we request that you do not take aspirin, but rather use Tylenol. A stronger pain reliever may be prescribed for you.
A small number of patients will experience some bleeding post-operatively. This bleeding can usually be controlled by the use of pressure. Apply constant pressure over the bleeding point for 15 minutes; do not lift up or relieve the pressure at all during that period of time. If bleeding persists, repeat the pressure for another 15 minutes. If this fails, call our office or visit a local Emergency Room. It is advisable not to drink alcohol the first postoperative night as this may stimulate bleeding.
A small red area may develop surrounding your wound. This is normal and does not necessarily indicate infection. However, if this redness persists or worsens, or the wound begins to drain pus, you should notify the nursing station at Edmonton Dermatology and Skin Surgery Centre at 780-450-7269.
Itching and redness around the wound, especially in areas where adhesive tape has been applied may indicate an allergic reaction. Similarly, you may react to the antibiotic ointment applied to the wound.
Swelling and Bruising
Swelling and bruising can occur after Mohs surgery, particularly when it is performed around the eyes. This usually subsides within 5-7 days after surgery and may be decreased by the use of an ice pack in the first 48 hours.
At times, the area surrounding your operative site will be numb to the touch. This area of anesthesia (numbness) may persist for several months or longer. In some instances, it may be permanent. If this occurs, please discuss it with your physician at your follow-up visit.
Although every effort will be made to offer the best possible cosmetic result, you will be left with a scar. The scar can be minimized by the proper care of your wound. We will discuss wound care in detail with you and give you a Post-Op Information Sheet that will explicitly outline how to take care of whatever type of wound you have.
Will I Develop More Skin Cancers?
After having one skin cancer, statistics say that you have a higher chance of developing a second one (50% of a second in the next 5 years). The damage that your skin has already received from the sun cannot be reversed. However, there are precautions, such as protecting
yourself from excessive sun exposure that can be taken to prevent further skin cancers. Routine skin checks with your family doctor or dermatologist can also help to catch and treat skin cancers early.