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Mohs Surgery Removes Skin Cancer Leaving Healthy Skin Intact

A type of skin cancer called basal cell carcinoma is the most common cancer. More than 1 million cases are diagnosed every year in the United States, and it is estimated that 20 percent to 25 percent of people will be affected. Fortunately, a specialized, state-of-the-art surgical technique called Mohs micrographic surgery can offer a 99 percent cure rate for basal cell carcinoma. There are fewer than 18 accredited Mohs surgeons in Illinois, and Loyola University Health System (LUHS) is one of the leading centers in the state for Mohs micrographic surgery.

There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Melanoma often is associated with prior sunburns but also can occur on skin that never sees the light of day. Melanoma can spread throughout the body, and treatment is difficult once this occurs.

Squamous and basal cell carcinoma are frequently associated with chronic sun exposure. They do not spread throughout the body, but that does not mean they can be ignored. These tumors never stop growing or disappear on their own and can be quite disfiguring, particularly on the head, face and neck. The presence of squamous or basal cell carcinoma indicates a greater chance of getting melanoma.

Mohs micrographic surgery is considered the gold standard treatment for squamous and basal cell carcinoma on the head, face and neck; skin cancers on the body that are greater than 2 centimeters in diameter; skin cancers with ill-defined borders; and recurrent skin cancers that have been treated previously. Mohs surgery is the treatment of choice for skin cancers in immunosuppressed individuals and people who have had radiation treatments for acne.

The traditional treatment for non-melanoma skin cancer is simply to remove it by cutting out the visible cancer. Within a few days, the tumor is sliced like a loaf of bread, and a few slices are examined by a pathologist for evidence of tumor roots. The pathologist does not see the entire bottom surface or all the edges of the cancer. Standard excision cures approximately 89 percent to 90 percent of cases. That means in about one in ten cases the cancer is not entirely removed. It comes back and requires further surgery.

“Tumors have roots. They grow like tree trunks in a swamp, and the root systems below the skin surface can be quite extensive,” said Steven J. Goulder, MD, a Mohs surgeon and chief of dermatologic surgery at LUHS.

The Mohs technique is very different and much more precise than standard excision. The Mohs surgeon removes a disc of tissue that includes the visible tumor and a small margin, and within 30 minutes microscopically examines the thin tissue layer for evidence of extended cancer roots. In this way, the entire bottom layer and borders of the tumor are observed. Using a special mapping technique and guided by the microscope, the surgeon can return to a specific area of the tumor site to remove more cancer cells if needed. This selective removal of diseased tissue enables the surgeon to preserve as much healthy tissue as possible. The Mohs surgeon also performs any necessary reconstruction during the same operation.

“The patient is cured and reconstructed on the same day,” Dr. Goulder said.

With Mohs surgery, less than one in 100 patients have recurrence of cancer, which is nearly a tenfold improvement over traditional excision.

To make an appointment with a dermatologist at LUHS, call (888) LUHS-888.