Skin Cancer Skin cancer is the most common type of cancer . More than 3.5 millionskin cancers are diagnosed annually in more than 2 million people. Current estimates are that one in five Americans will develop skin cancer in their lifetime. Basal cell carcinoma (BCC) and squamous cell carcinomas (SCC) are the two most common forms of skin cancer, but both are easily treated if detected early. These tumors most commonly arise from genetic mutations in the skin caused by sun damage. Fair complexion, light eyes (blue, green, hazel) and family history of skin cancer all increase a person’s risk for developing skin cancer. Patients who take immune-suppressing medicines, those with a history of bad sunburns or certain medical conditions (leukemia) are also at increased risk for developing skin cancers. If not completely removed, skin cancers invade and destroy important structures. Although basal cell carcinomas rarely metastasize (spread to other parts of the body), squamous cell carcinomas can develop and spread more quickly. Melanoma , the third most commontype of skin cancer is the most likely to spread and can be very dangerous. Melanoma is most commonly treated by excision with a margin, but is treated by Mohs surgery in some instances. Mohs Surgery Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancers, typically of the head and neck. Certain tumors of the rest of the body are sometimes treated with Mohs surgery as well. The technique offers two main advantages over traditional skin cancer removal treatments: • The highest cure rate . Mohs surgery for primarybasal cell carcinoma, for example, has a 98- 99% cure rate. • Tissue sparing . Because Mohs surgery is a tissuesparing surgery, where only the skin with tumor in it is removed, the patient is left with the smallest defect possible. Smaller defects mean smaller scars in the end, after the defect is closed. In traditional excisions, the edges are not checked in "real-time" so safety margins are necessary. This often leads to larger defects and eventually larger scars. On the face, even a couple of millimeters difference in a scar length can make a big cosmetic difference. (See below for more about scars.) Not all tumors require Mohs surgery and other good treatments are available for skin cancer. The most common treatment for skin cancer is physical destruction by either cryotherapy (freeze-treating) or curettage with electrodessication (scrape & burn). Topical chemotherapy (prescription cream) is sometimes used for pre-cancer or very early skin cancers. A newer technique for treating early tumors include photodynamic therapy (PDT), whereby a medicine is applied to the treatment site and later activated by narrow-band light therapy. Tumors without aggressive features in areas that do not require tissue sparing may also be treated by standard excision (cutting the tumor out and immediately sewing it up, without checking to see if it is clear first). Mohs surgery involves a same-day procedure where an initial "layer" is taken (the clinical tumor) and examined under the microscope for any involvement of the edges while the patient waits. The tissue is mapped in such a way so that if there is tumor at any one edge, the surgeon knows exactly which edge this is and can go back to take another small piece of skin from this edge only (instead of another whole circle around the defect, leaving a larger defect than necessary). Repair/Reconstruction Once the Mohs surgery is complete, you will have a wound or defect where the cancer was located. This wound can vary in size but will always be larger than what was seen initially with the naked eye. The second part of the procedure is repairing this wound. Although Mohs surgery allows for maximal tissue preservation, all surgery results in a scar. Your provider is an experienced reconstructive surgeon and will review the options and recommend the repair that would likely result in the best cosmetic and functional outcome. Common Types of Repairs:
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