Mohs Surgery for Skin Cancer
Mohs Micrographic Surgery for Treating Skin Cancer
Now the most common form of cancer in the U.S., 1 in every 5 Americans will develop skin cancer in our lifetimes, and it’s even more likely in sunbelt locales such as Charleston. When caught and treated early, with a procedure called Mohs Micrographic Surgery, the most advanced, precise and effective treatment for a wide variety of skin cancer types, the success rate is 99%* (*source: ACMS)
Dermatologists do more skin surgeries by far than any other specialty and as skin cancer experts, they are the only physicians that can be trained in Mohs Surgery This surgery is performed in our office by Todd Schlesinger, MD, FAAD, FASMS and Brandon Coakley MD, FAAD, FACMS.
How is Mohs Micrographic Surgery different from a standard excision?
During standard excisions, a football shaped piece of tissue including and surrounding the skin cancer is removed. The tissue is sliced top to bottom and laid onto slides for examination. While this is often adequate for skin cancers on the arms, torso or legs where there may be extra skin to take a wider margin, it is not ideal for cosmetically sensitive areas such as the face and hands.
Mohs Surgery, considered the ‘gold standard’ in skin cancer treatment, involves removing the cancer in stages that begin with a saucer-like piece of skin that includes the tumor plus a small margin of surrounding skin. The tissue is mapped, inked and processed onto slides for microscopic examination in such a way that 100% of the surgical margin can be determined. If skin cancer cells are seen in the removed tissue, another stage is removed in the exact location, leaving normal skin intact. By this method, as many non-cancerous skin cells as possible are saved. Once the skin cancer has been completely removed, Dr. Schlesinger or Dr. Coakley will explain various options for closure and repair of the wound.
How Effective is Mohs Surgery?
Because the Mohs Micrographic Surgery process involves a systematic microscopic search which traces skin cancer extensions until they are undetected, it offers the highest chance for cure while sparing the surrounding normal tissues. Studies performed around the world have repeatedly demonstrated that Mohs surgery has a 99% five-year cure rate for new skin cancers and a 95% rate for recurrent cancers.
Why Has Mohs Surgery Been Recommended for my Skin Cancer?
Mohs Micrographic Surgery treats basal cell and squamous cell carcinomas and certain melanomas. Following a biopsy, your skin cancer may not be visible, however more tumor cells may remain in the skin. These tumors have roots, just like a tree and if not removed, may reappear and require more extensive surgery. Or they can invade and metastasize to the lymph nodes and other organs in the body. The Mohs process allows us to examine 100% of the tissue edge to ensure that those roots are completely removed, virtually eliminating the chance of the cancer growing back.
What Kind of Training is Required to Perform Mohs Micrographic Surgery?
Dermatologists and surgeons without Mohs training have to guess about the breadth and depth of tumor roots, so they may end up removing additional healthy skin and leaving larger scars. Having a doctor who is both the surgeon and the microscopic pathologist makes a real difference.
Todd Schlesinger MD, FAAD, FASMS – Graduating magna cum laude and with Phi Beta Kappa honors from the State University of New York at Buffalo, he was accepted to medical school at the State University at Buffalo School of Medicine during his sophomore year in college. He was inducted into the prestigious medical honor society Alpha Omega Alpha during his junior year, as well as, receiving special honors in anatomy and pathology winning entrance into the Gibson Anatomical Society and the Pathology Honor Society. As a recipient of a National Cancer Institute Fellowship at the internationally recognized Roswell Park Cancer Center, he earned the opportunity to work with globally acknowledged dermasurgeons in the field of skin cancer resection. Dr. Schlesinger completed his internship and dermatology residency at the world renowned Cleveland Clinic Foundation and subsequently trained and tested to become a Fellow of the American Society for Mohs Surgery. He has further trained in dermatologic surgery at the Scripps Clinic in La Jolla, California. He is board certified by the American Board of Dermatology, a fellow of the American Academy of Dermatology, American Society for Dermatologic Surgery and the American Society for Laser Medicine and Surgery. With almost 20 years of Mohs Surgery experience, Dr. Schlesinger is one of the most formidable Mohs surgeons in South Carolina.
Brandon Coakley MD, FAAD, FACMS – Graduating with a Bachelor of Science in Biochemistry from Loyola Marymount University, he began his medical career by doing surgical research at Mayo Clinic Arizona and went on to medical school at the University of Arizona, followed by an Internal Medicine internship at Johns Hopkins University/Sinai Hospital. He completed a residency at the University of California, Irvine where he trained in medical, surgical and cosmetic dermatology. Dr. Coakley has extensive training in complex dermatology, and special interest in skin cancer management. Board-certified by the American Academy of Dermatology, he remained at UC Irvine for a highly coveted ACGME-accredited fellowship in Cutaneous Oncology and Micrographic Surgery. An expert in the Mohs micrographic technique for skin cancer removal on the face, hands and genital skin, as well as reconstruction after cancer removal, he is a Fellow in the American College of Mohs Surgery.
How Cost-Effective is Mohs Surgery?
Because of the high success rate of Mohs Surgery, most patients require only a single surgery. The surgery cost also includes the pathology readings and repair of the wound as well. Treatment in our office is often performed at a lower cost than typically incurred in a hospital or surgery center.
What will Mohs Surgery Day Be Like?
Mohs Surgery is performed in our office as an outpatient surgery under local anesthesia; meaning that the area to be treated is numbed throughout the procedure until you go home. Your Mohs Surgery day usually begins early morning to mid-day, between 7:45am-1:00pm. You are asked to have breakfast, take your medications and drink plenty of water, while avoiding caffeine as it may interfere with the anesthesia. Please be sure to ask your doctor or a clinical staff member about any prescription medications prior to your surgery date.
Once the first stage has been removed, you’ll wait in one of our comfortable lounges while the skin samples are examined in real-time by either Dr. Schlesinger or Dr. Coakley. If necessary, you’ll be called in for a second or additional stage. Once the cancer has been completely removed, your reconstruction will be discussed with you and performed in one of our surgical suites.
Our Mohs lounge is complete with television, reading material and beverages. We ask that you limit the number of accompanying family or guests to one and that no children be brought with you or your guest on the day of surgery.
If you have any questions about an upcoming Mohs Surgery date or would like to schedule an appointment to have your skin examined by our board-certified dermatologists or physician assistants, please contact our office.