Mohs Surgery and skin cancer
James Rosing, M.D., F.A.C.S. Mohs Reconstruction
Mohs surgery is a technique of skin cancer removal maintaining as much of the adjacent uninvolved skin as possible.
Dr. James Rosing has focused on Mohs reconstruction and skin cancer treatment over the past eight years. He is regarded as one of Orange County’s most highly sought after plastic surgeons for Mohs micrographic reconstructive surgery. At Rosing Plastic Surgery, we structure our schedule to allow for same-day Mohs excision and repair by coordinating with local dermatology Mohs treatment centers. Dr. James Rosing has and continues to work with dermatology leaders in Mohs such as Dr. Lisa Bukaty, Dr. Kathleen Hutton, Dr. Joannie D. Sun, and Dr. Suzanne Kilmer of the Laser and Skin Surgery Center of Northern California.
About 96 percent of the 1.3 million new cases of skin cancer diagnosed each year in the United States is basal cell or squamous cell carcinoma. When treating these cancers, Mohs micrographic surgery has typical cure rates of more than 99 percent for new skin cancers and 95 percent for recurrent skin cancer. Mohs technique is not a standard method of treatment for Melanoma skin cancer. Mohs micrographic surgery is also known as chemosurgery and is a technique of skin cancer removal maintaining as much of the adjacent uninvolved skin as possible.
Mohs technique is utilized as a primary method of skin cancer treatment for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the head, neck, hands, feet, and genitalia with a 99% cure rate. For BCC and SCC located on the chest, back, arms, and legs, excision with margins dictated by the National Comprehensive Cancer Network, (NCCN) guidelines for BCC and SCC, remains the standard method for primary treatment and carries up to a 97% cure rate. Mohs technique is used as a secondary method for excision of BCC and SCC of the chest, back, arms, and legs should an excised specimen have an involved margin.
Mohs Excision and Repair
The Mohs surgical process involves a series of excisions followed by microscopic examination of the tissue to assess if any tumor cells remain. Some tumors that appear small on clinical exam may have extensive invasion below normal appearing skin. In many cases, it is impossible to predict a tumor size until all surgery is complete. As Mohs surgery is used to treat complex skin cancers, about half of the tumors require removing two or more layers of tissue for complete excision.
Step 1 — Anesthesia
The tumor site is locally infused with anesthesia to completely numb the tissue. General anesthesia is not required.
Step 2 — Removal of Visible Tumor
Once the skin is numbed, the tumor is gently scraped with a curette. This helps define the clinical margin between tumor cells and healthy tissue. The first thin, saucer shaped "layer" of tissue is then surgically removed by the Mohs surgeon. An electric needle may be used to stop bleeding.
Step 3 — Mapping the Tumor
Once a "layer" of tissue has been removed, a "map" or drawing of the tissue and its orientation to local landmarks, such as the nose and cheek, is made to serve as a guide to the precise location of the tumor. The tissue is labeled and color-coded to correlate with its position on the map.
The tissue sections are processed and then examined by the surgeon to thoroughly evaluate for evidence of remaining cancer cells. It takes about an hour to process, stain and examine a tissue section. During this processing period, the wound is bandaged.
Step 4 — Remove Additional Tissue
If any section of the tissue demonstrates cancer cells at the margin, the surgeon returns to that specific area of the tumor, as indicated by the map, and removes another thin layer of tissue only from the precise area where cancer cells were detected. The newly excised tissue is again mapped, color-coded, processed and examined for additional cancer cells. If microscopic analysis still shows evidence of disease, the process continues layer-by-layer until the cancer is completely removed.
This selective removal of tumor allows for preservation of much of the surrounding normal tissue. Because the systematic microscopic search reveals the roots of the skin cancer, Mohs surgery offers the highest chance for complete removal of the cancer while sparing the normal tissue.
Step 5 — Reconstruction
Dr. James Rosing specializes in the reconstruction of Mohs defects and has focused the reconstructive side of his practice on Mohs repair since 2011. Reconstruction is individualized to preserve normal function and maximize aesthetic outcome. The best method of repairing the wound following surgery is determined only after the cancer is completely removed, as the final defect cannot be predicted prior to surgery.
Stitches may be used to close the wound side-to-side, or a skin graft or a flap may be designed to transfer adjacent tissue. In some cases, a wound may be allowed to heal naturally, referred to as healing by secondary intention.
While most Mohs excisions will result in a very small defect, the location of the defect being on the face, nose, eyelid, ear, or lip requires a careful technique of repair to avoid a distracting scar. Dr. James Rosing has an excellent track record of Mohs repair, with consistently outstanding results.
Come to our office where Dr. James Rosing will combine years of knowledge and experience in treating Mohs defects with a professional and kind bedside manner to optimize your result in Mohs surgery. Our friendly and knowledgeable staff will make you as comfortable as possible during Mohs surgery and repair as well as ensure the most timely scheduling. Thank you for your interest in Rosing Plastic Surgery.
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