A diagnosis of skin cancer can be unsettling, but we have the expertise and training that offers the best possible outcomes.
Mohs surgery is the most advanced, state-of-the-art treatment for skin cancer. It has up to a 99% cure rate — the highest of all treatments.
Mohs surgery is the most advanced and precise technique available for treating skin cancers. It is named in honor of Frederic Mohs MD, the doctor who developed the technique. When skin cancer is removed with Mohs surgery, there is no guessing if the tumor is completely removed. This is because Mohs surgery uses a microscope to look at 100% of the edges. This is the only way to make sure that the tumor is completely removed. When other methods are used to remove skin cancer, the doctor is mostly guessing about whether they have completely removed the tumor. Mohs surgery removes only the cancer cells and leaves the surrounding normal skin untouched.
The unaided eye of even the most-experienced surgeon is not as good as a microscope. For decades, surgeons removed only the visible parts of a skin cancer, often leaving behind the cancerous roots. This is why Mohs surgery does not rely on the naked eye to identify the edges of the tumor. Instead, the Mohs surgeon uses a map and a microscope to pinpoint the exact area where skin cancer remains. This removes the guessing that comes when skin cancer is treated with other methods.
Mohs surgery is considered the gold standard in the treatment of skin cancer. This is because Mohs surgery offers two benefits:
First, it provides the highest chance for a cure.
Second, it saves as much normal skin as possible.
With Mohs surgery, the cure rate is as high as 99% for most skin cancers. This is true even after other treatments have failed. Other common methods of treatment for skin cancer include regular (non-Mohs) surgery, scraping and/or burning, freezing, radiation and topical creams. All of these types of treatment offer much lower cure rates than Mohs surgery and some result in larger wounds.
Dr. Burnett is one of the few dual board-certified and fellowship-trained Mohs and reconstructive surgeons in the country. This means that Dr. Burnett is board-certified in Mohs Micrographic Surgery, as well as board-certified in Dermatology. Most importantly, he completed an additional year of specialized training on both skin cancer pathology and facial-plastic reconstruction. As a fellowship-trained Mohs surgeon, he acts as both the surgeon and pathologist for the removal of skin cancer. Among fellowship-trained Mohs surgeons, he is one of only a small number in the country to have been formally trained to use special staining techniques to treat both high-risk and rare skin cancers.
Here's a helpful chart comparing microscopically-controlled (Mohs) surgery versus Image-Guided Superficial Radiation Therapy (SRT) comparison.
Most skin cancers can be easily treated using standard Mohs surgery tissue stains. However, some types of skin cancer are better visualized using specialized stains which highlight the cancerous cells when they are being looked at under the microscope. These stains are a type of "immunohistochemistry" (IHC), which utilizes special antibodies that target the cancerous cells. Depending on your particular type of skin cancer, Dr. Burnett may use these stains so that he can ensure complete removal of any cancerous roots that might otherwise be missed when standard techniques are used. Dr. Burnett has particular expertise in using special stains to treat melanoma (see photo above), including desmoplastic and spindle cell melanomas, extramammary Paget's disease, poorly-differentiated squamous cell carcinomas and others.
Dr. Frederic E. Mohs developed the Mohs surgical procedure in the 1930s. Since then, it has been refined and perfected in order to offer patients today the best possible outcomes.
As developed by Dr. Mohs, the basics of the procedure involved color-coding the removed specimens and then mapping them to accurately identify the location of any remaining cancerous cells. Similarly, Mohs surgeons today excise the visible tumor as a "stage" or "layer" of tissue which is then color-coded, mapped, frozen, sectioned, and immediately examined with a microscope by the Mohs surgeon.
This microscopic examination is the definitive part of the Mohs surgical procedure, which reduces the normal treatment time to a single visit, and allows for immediate reconstruction of the wound.
Clinical studies have shown that Mohs surgery has up to a 99% cure rate over five years when used to treat melanoma, basal cell carcinoma, squamous cell carcinoma and other skin cancers. For cancers that have failed other treatments, the cure rate is up to 95%.
The Mohs surgical procedure includes a specific sequence of surgery and pathological investigation.
Once the visible tumor is removed, the Mohs surgeon:
- Removes a thin layer of normal-looking tissue from around the tumor site
- From this, a “map” or drawing of the removed tissue is created as a guide to the precise location of any remaining cancer cells
- Once the tissue is processed, the Mohs surgeon microscopically examines 100% of the surgical margin to find any remaining cancer cells
If any of the sections contain cancer cells, the Mohs surgeon:
- Returns to the precise location of the residual tumor indicated by the map
- Removes another thin layer of tissue only from the specific area(s) where cancer cells were detected under the microscope
- Processes the removed tissue and then microscopically examines the newly removed tissue for any additional cancer cells
If microscopic analysis still shows evidence of cancerous cells, the process continues until the cancer is completely eradicated. There is no way to know how far out the microscropic roots of a tumor may extend, this is why it may take more than one stage or layer to fully remove a skin cancer.
Most patient do not understand that when skin cancers are not treated in a microscopically controlled (Mohs) manner, they will often come back. This is because non-Mohs treatments rely on the naked eye to determine how much to remove. Without checking 100% of the edges with a microscope, a recurrence of cancer may occur. In some instances, the tumor may recur more deeply than it had started out.
In the right hands, Mohs surgery is considered the gold-standard for the treatment of nearly all skin cancers. Your dermatologist may recommend Mohs surgery when:
- They want you to have the highest cure rate possible
- The cancer is in an area where it is important to preserve healthy tissue, both for functional and cosmetic reasons (i.e. eyelids, nose, ears, lips)
- The cancer was previously treated and then came back (i.e. "recurred")
- Scar tissue exists in the area of the cancer
- The cancer is large
- The edges of the cancer cannot be clearly defined
- The cancer grows rapidly or uncontrollably
Dr. Burnett has special training in complex reconstructive procedures needed to repair the wound. Some wounds may heal on their own, or may be closed with stitches, a skin graft or a skin flap.
The method for managing the wound will be determined after the cancer is completely removed. Reconstruction is individualized by Dr. Burnett to achieve the best results possible, preserving function and maximizing aesthetics.
Mohs surgery is comparable to the cost of other skin cancer removal procedures, including electrodesiccation and curettage, cryosurgery, excision or radiation therapy. Mohs surgery minimizes the risk of recurrence, eliminating additional costs of larger procedures for recurrent cancers. The Mohs procedure is also usually completed in a single day and preserves the maximum amount of normal skin tissue, which results in smaller scars.
Only dermatologists can do Mohs surgery. This is because the foundation of Mohs surgery is the evaluation of skin through a microscope. Dermatologists gain this foundation during a dermatology residency which is then verified by a board-certification exam taken after residency. To become a fellowship-trained Mohs surgeon, a board-certified dermatologist must then be accepted into a highly-competitive one or two-year fellowship accredited by the American College of Mohs Surgery (ACMS), during which the physician receives comprehensive training in all aspects of Mohs surgery, pathology and facial-plastic reconstructive surgery. However, not all fellowships are the same and patients should take the time to research their Mohs surgeon carefully.
Whatever your skincare needs, now is your time to prioritize your dermatological health.
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