Dr. Norman Lockshin : DermAssociates
Mohs Surgery
Description
In the early 1940s, Dr. Frederic Mohs, Professor of Surgery at the University of Wisconsin, developed a form of treatment for skin cancer, which he called chemosurgery. (The word “chemosurgery” is derived from the words “chemical” and “surgery.”) The technique has undergone many refinements and came to be known as “Mohs surgery” in honor of Dr. Mohs.
Mohs surgery is a highly specialized treatment for the total removal of skin cancer, in which the microscope is used to determine the extent of the tumor and its location.
Surgical Procedure
The surgery is performed as follows: The skin that is suspicious for cancer cells is treated with a local anesthetic so that there is no feeling or pain in the area. To remove most of the visible skin cancer, the tumor is scraped using a sharp instrument called a curette. A thin piece of tissue around the scraped skin is then removed surgically and is carefully divided into pieces that will fit on a microscope slide.
Examination of Tissue
During the post-surgery examination, the tissue edges are marked with specially colored dyes, and a careful diagram of the removed tissues is made and frozen by a technician. Thin slices are then made from the frozen tissue and examined by Dr. Norman Lockshin under the microscope. Most bleeding from the procedure is controlled using pressure and other routine measures; occasionally a small blood vessel is encountered which must be tied using suture material. A pressure dressing is applied, and the patient is asked to wait in the reception area while the slides are being processed.
Dr. Norman Lockshin examines the slides under the microscope to determine if any tumor remains. If cancer cells are present, he is able to judge the number of cells and the exact location. Another layer of tissue is then surgically removed, and the procedure is repeated until the physician is satisfied that the entire base and sides of the wound are free of cancer cells. As well as ensuring total removal of the cancer, this process preserves as much normal, healthy, surrounding skin as possible. The goal is to remove the cancer while creating the smallest possible loss of normal tissue.
Duration of Surgery
The removal of each layer of tissue takes one to two hours. Only 20 to 30 minutes of that time is spent in the actual surgical procedure. The remaining time is required for slide preparation and interpretation. Removal of two or three layers of tissue (called ’stages’) is usually necessary to complete the surgery. Therefore, if Mohs surgery is started early in the morning, it is generally completed in one day. Occasionally, however, a tumor may be extensive enough that surgery is carried over to a second day.
Rate of Cure
By microscopically pinpointing areas filled with cancer and selectively removing these tissues, Dr. Norman Lockshin can successfully remove your skin cancer. Using this technique, the rate of success is very high, often 95 to 99 percent, even if other forms of treatment have failed. However, no one can guarantee a 100 percent success rate.
Since normal tissue is preserved to the greatest extent possible, Dr. Norman Lockshin is also able to offer you the best possibility of a good cosmetic result, and every effort will be made to minimize the scar.