FRIDAY, Aug. 16, 2002 (HealthDayNews) -- It's called the Mohs procedure, and it's considered the gold standard for treating many skin cancers, but few people have ever heard of it.
Some doctors think the painstaking procedure is not always necessary, but surgeons trained in the practice note it's critical to remove tumors completely the first time around since they're tougher to treat if they return.
According to the American Cancer Society, about 1.3 million cases of non-melanoma skin cancer are diagnosed each year. In 2002 alone, 2,200 people will die of these cancers.
The good news is this type of skin cancer is almost 100 percent treatable when found early. The goal of treatment is to remove or destroy the cancer completely, with as small a scar as possible.
Options include surgery, curettage and electrodessication, cryosurgery, laser therapy, radiation and topical chemotherapy and Mohs surgery.
Over the past 30 years, a growing number of patients and doctors are opting for the Mohs technique, which was first developed by Dr. Frederic Mohs at the University of Wisconsin in 1936.
"It's a relatively new surgical procedure in medicine, but it has now become the standard of care for certain tumors," says Dr. Matthew Brett Quan, a Mohs surgeon at the Center for Dermatology, Cosmetic and Laser Surgery in Mount Kisco, N.Y. Quan spent a year studying the procedure, and has been a Mohs surgeon since 1996.
The Mohs procedure is used when a doctor doesn't know the shape or depth of a tumor; when the tumor is in a hard-to-treat area such as the nose, eyelid or face; or when the tumor is a recurrence. In these instances, many insurers will cover the costs of the procedure.
Surgery generally takes place in an outpatient setting. After applying a local anesthetic to the affected area of the skin, the Mohs surgeon removes a thin layer of skin, marks its location, and examines it under a microscope.
The tissue is mapped on a color-coded grid so the surgeon can pinpoint the corresponding location on the wound. If cancerous tissues are still found, the process is repeated until the slides are cancer-free.
Because it can take up to an hour to examine each slide, the procedure can take half a day or more to complete. If the tumor is extensive, it may take more than a day.
The major difference between the Mohs technique and conventional surgery is the precision achieved by using the microscope to inspect samples of skin. This conservative approach maximizes the saving of healthy tissue, resulting in faster healing and better cosmetic results. Reconstructive surgery isn't needed unless the wound is very large.
However, unless a patient has had skin cancer before or knows someone who has, how likely are they to find a Mohs surgeon or look for one?
"Unfortunately you totally rely upon your dermatologist, your family practitioner, or whoever did your biopsy to tell you where to go and what to do," Quan says.
He suggests patients educate themselves through the Internet, and cautions that some dermatologists are doing the procedure with only minimal training.
Dr. Robert Greenberg is a dermatologist in Vernon, Conn., and a member of the American Academy of Dermatology. He believes the surgery is appropriate under certain circumstances and refers patients, as necessary, to qualified Mohs surgeons. However, he says many non-melanoma skin cancers can be treated adequately with conventional techniques.
"These procedures are much less costly, less invasive and easier on the patient," Greenberg says.
Moh's is time-consuming, labor-intensive and generally costs more than twice the price of any treatment except radiation, leading some critics to call the procedure "fee-effective."
Quan disagrees: "You get a smaller scar and a higher cure rate. Why not do it? They're harder to get out the second time around."
What To Do
Visit the Mohs College of Surgeons for more on the procedure and how to find Mohs surgeons.
The American Academy of Dermatology has more on skin cancer.
