One of the most challenging things about treating skin cancer is, what you see is not what you get. A skin cancer lesion may look small or minor on the skin’s surface yet have extensive deep or lateral growth underneath the skin.
Picture an iceberg floating in the ocean. Only a portion of the iceberg sits above the water where you can see, yet the part that’s submerged is massive. Skin cancer works the same way. What you see on the surface may not prepare you for what lies under the skin.
Because there’s uncertainty in knowing how much the skin cancer has grown below the skin’s surface, dermatologists consider many factors to determine the most effective procedure for removing all skin cancer cells the first time around.
They consider the type of skin cancer, its visible size, severity, and where it is on the body.
Whenever possible, dermatologists choose Mohs micrographic surgery, the Gold Standard for skin cancer removal for these 7 reasons…
1. Mohs surgery has the highest skin cancer cure rate
Mohs micrographic surgery has the highest cure rate of any skin cancer procedure. It’s more effective than traditional wide surgical excisions, curettage and electrodesiccation (removal and cauterizing the skin) and cryotherapy (freezing with liquid nitrogen).
Studies show that Mohs surgery has a 99% cure rate for skin cancers that have not had previous treatment. In skin cancers that have received prior treatment, Mohs cure rate is 94%.
What makes Mohs surgery different from other procedures is that it’s the most precise method for curing skin cancer while preserving as much surrounding skin as possible.
Unlike traditional surgical excisions, where cancerous tissue and a wide margin are removed and sent out to a lab to make sure margins are clear, Mohs surgery removes smaller sections of skin in stages and allows for rapid microscopic evaluation of skin cancer cells. Your Mohs surgeon identifies the exact borders of healthy vs. cancerous tissue, being sure to keep healthy skin intact.
No other skin cancer intervention is so precise.
This level of precision is crucial when tackling skin cancers like basal cell carcinomas (BCCs) (especially on the face), which may visually appear small yet tend to grow deep and have irregular spreading patterns. Additionally, BCCs are significantly harder to treat the second time around.
Squamous cell carcinomas (SCCs) are a more invasive skin cancer but are curable with Mohs surgery when detected early. If left untreated or not entirely removed, SCCs can spread to other parts of the body, possibly requiring immunotherapy treatment.
2. Mohs has a low recurrence rate
When skin cancer is recurrent, meaning cancer comes back after treatment, it’s even harder to treat. Your dermatologist minimizes the risk of having to retreat difficult skin cancers by performing Mohs surgery.
Your Mohs surgeon is also your pathologist, examining skin tissue at a cellular level and analyzing 100% of the skin border under the microscope. He/she maps out the exact areas of skin tissue where the cancer is clear. The process isn’t over until your margins (borders) are cancer-free.
The Mohs technique ensures the removal of all existing skin cancer, preventing a recurrence down the road.
In one Mohs study, patients with previously untreated BCC skin cancers had a 2.1% recurrence rate after Mohs. Patients in the same study that received Mohs treatment for recurrent BCC skin cancer had a 5.2% recurrence rate. To give you an idea of how Mohs compares against other skin cancer treatments, the average recurrence rate for BCC with wide surgical excision is 10.1%
Mohs has promising results for SCC rate of recurrence also. Patients who had SCCs on the lips that had never had treatment had a recurrence rate of 3.1% with Mohs vs. 10.9% with other treatment modalities and those with an SCC on the ear had a 5.3% recurrence vs. 18.7% with other modalities.
Overall, skin cancers are cleared completely with Mohs surgery and the recurrence rate is exceptionally low.
Mohs surgery is the most accurate procedure for removing all skin cancer cells in and around the area with minimal scarring, leaving the best cosmetic outcome.
3. Mohs surgery is preferred for visible, delicate and high functioning areas of the body
The Mohs technique is so targeted that the surgeon removes only the skin tissue affected by cancer, keeping all surrounding healthy skin tissue intact, leaving behind the smallest skin flaw possible. This accuracy is hugely vital for removing skin cancers on the face that could otherwise leave cosmetic imperfections.
This intricate procedure allows them to work safely on the face and body’s most fragile areas, including eyelids, ears, lips, nails, and genitalia. For high functioning areas like hands and feet, Mohs surgery leaves behind the smallest scar possible to ensure full use and range of motion in the area.
Mohs surgeons are highly trained in cosmetic surgery to restore the skin as close to cosmetically perfect as possible.
4. Mohs surgery leaves behind minimal scarring
Dermatologists are sympathetic to the emotional distress caused by visible scars. Most (about 80%) BCCs and SCCs are located on the head and neck, and defects left behind from the lesions or cancer treatments can cause stress, anxiety and physical discomfort.
Mohs is the preferred procedure for leaving the smallest area of scarring possible. Your Mohs surgeon is highly-trained in reconstructive surgery. He/she has completed an American College of Mohs Surgery (ACMS) accredited fellowship, and has trained under leaders in dermatologic surgery, facial plastic surgery, and eyelid plastic surgery.
5. You’ll know your results the very same day
Unlike other skin cancer treatments or surgeries, your Mohs surgeon knows how much skin cancer is removed during each stage of the process and can tell you when your skin is officially cancer-free. For most Mohs surgeries, the patient is cancer-free the same day.
In contrast, with traditional excision surgery, the surgeon removes skin cancer and surrounding tissue and sends it to an outside lab. After a few days, you’ll receive results of whether or not the entire tumor was removed and if you’ll require additional surgery.
Excisional surgery isn’t ideal for all skin cancers. The irregular cancer growth makes it difficult to estimate how deep the tissue removal should be, leaving the possibility of performing another surgery.
Cryotherapy (freezing with liquid nitrogen) is used for very superficial skin cancers because it only destroys cells on the skin’s surface. There’s no way to know if skin cancer is completely gone or if it will return in that area. Curettage is a method to scrape away skin cancer cells but is not as precise and does not assess margins. This procedure leaves behind a scar and the potential for additional surgeries and recurrent skin cancer.
The feeling of knowing you have skin cancer brings on a lot of anxiety and uncertainty. The ability to have your skin cancer treated with the highest cure rate all in one day is reassuring for patients and doctors.
6. Mohs surgery is convenient for patients
Unlike other surgeries, preparation for Mohs surgery is minimal. You’re not required to fast the night before or arrive exceptionally early for the surgery day.
You have the whole procedure done in one location, in one day, by a dedicated and fellowship-trained Mohs Micrographic Surgeon. Your Mohs Surgeon is a highly specialized physician that will accurately remove your skin cancer, interpret microscope slides, and reconstruct your surgical area. There’s no need to fill your calendar with multiple doctor visits, wait for results or confuse your care between multiple physicians.
Mohs Surgery is an efficient and safe method to accurately treat skin cancer.
7. Mohs is cost-effective for the health system
Mohs surgery is an incredibly cost-effective option for treating skin cancer. There is no need for general anesthesia or being in an operating room. Since the surgery is performed in the office, the infection rate is much lower. Your Mohs surgeon will be able to take care of the large majority of skin cancers without you needing to see any other physicians. This will reduce any impact on patient’s lives given the higher cost of care with going to the hospital and needing to see multiple physicians.
Mohs surgery completely removes skin cancer, has the lowest recurrence rate, and streamlines the skin cancer surgery, repair and healing experience, leaving the slightest skin defect possible.
To learn more and speak to a provider about Mohs surgery call Ohio Skin Center for a consultation.