Mohs surgery

From Wikipedia, the free encyclopedia

It has been suggested that Mohs cancer surgery be merged into this article or section. (Discuss)

REDIRECT Mohs cancer surgery

Mohs Surgery is microscopically controlled surgery that is highly effective for common types of skin cancer, with a cure rate of up to 99% for basal cell carcinoma, the most common type of skin cancer, and for squamous cell carcinoma. Because the Mohs procedure is micrographically controlled, it provides precise removal of the cancerous tissue, while healthy tissue is spared. For this reason, Mohs surgery results in a significantly smaller surgical defect and an improved cosmetic result compared to other methods of skin cancer treatment. The Mohs procedure is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desired for cosmetic and functional purposes (the face, eyelids, nose, ear, fingers, genital area), for cancers with indistinct margins, and for recurrent cancers in scar tissue. It is especially indicated for lesions that have recurred following prior treatment, or for lesions in anatomic areas that have the greatest likelihood of recurrence (eg., the side of the nose).

Mohs surgery is expensive. For this reason, it should be used generally only for recurrent, indistinct or facial cancers.

1 Mohs procedure
2 About Mohs surgeons
3 See also
4 External links

[edit] Mohs procedure

Mohs surgery is performed by a Mohs skin cancer surgeon in four steps:

Surgical removal of tissue (surgical oncology)
Mapping the piece of tissue, freezing and cutting the tissue between 5 and 10 microns using a cryostat, and staining with H&E
Interpretation of microscope slides (pathology)
Reconstruction of the surgical defect (reconstructive surgery)

After each surgical removal of tissue, the specimen is processed, cut on the cryostat and placed on a slides, stained with H&E and then read by the Mohs surgeon who examines the sections for cancerous cells. If cancer is found, its location is marked on the map (drawing of the tissue) and the surgeon removes the indicated cancerous tissue from the patient. This procedure is repeated until no further cancer is found.

Thus, Mohs surgery requires expertise in frozen section microscopic interpretation and in the surgical technique of excising the cancer and repairing the defect in a cosmetically acceptable manner. This training is done during many general dermatology residencies. As with other surgical specialties, many mohs surgons complete an additional 1 to 2 years of post-residency fellowship.

[edit] About Mohs surgeons

The Mohs surgeon must understand the biologic behavior of several types of skin tumors in order to provide comprehensive management of cutaneous oncology. The Mohs surgeon must have extensive training in the surgical removal of skin cancer, the microscopic analysis (pathology) of the tumor, and reconstructive surgery of the skin and underlying structures. In addition, Medicare requires that the same physician serve as surgeon and pathologist. All Mohs surgeons must have a CLIA certified laboratory. The American Academy of Dermatologyis the largest organization of board certified dermatologists many of whom perform dermatologic and Mohs surgery. With a membership of over 15,000, it represents virtually all practicing dermatologists in the United States and Canada and has specific member information regarding those performing Mohs micrographic surgery. The American Society of Dermatologic Surgery founded in 1970 is the largest organization of board certified dermasurgeons with nearly 4000 members who perform dermatologic surgeries including Mohs Micrographic Surgery. The mission of the Society is to promote excellence in the subspecialty of dermatologic surgery and foster the highest standards of patient care. Additionally, the American Society for Mohs Surgery is a non-profit professional medical society of over 800 dermatologists, pathologists, and Mohs technicians. Founded in 1990, the ASMS is dedicated to the highest quality patient care and education relative to Mohs surgery as a specialized surgical treatment for skin cancer. The American College of Mohs Micrographic Surgery and Cutaneous Oncology was established in 1967 and named after Frederic Mohs, who first developed the technique. This organization's members are dermatologists who have become proficient and experienced in the use of Mohs Micrographic Surgery. In order to become a member of this college, physicians must be board certified in a field of surgery (usually dermatology) and then complete an additional 1 to 2 years of post-graduate fellowship with exposure to complex tumors and reconstructive plastic surgery of the skin. The College has grown to nearly 800 members. There are other organizations which may not require fellowship training. These College sponsored fellowships are not recognized by the The Accreditation Council for Graduate Medical Education. The official medical journal for Mohs surgery, Dermatologic Surgery, is published by the American Society for Dermatologic Surgery and is the official journal of The American College of Mohs Micrographic Surgery and Cutaneous Oncology and the official publication for the American Society for Dermatologic Surgery. The Board of Medical Subspecialities considers Mohs micrographic surgery as part of the field of dermatology and does not recognize it as a separate subspeciality. The The Accreditation Council for Graduate Medical Education is responsible for the accreditation of post-MD medical training programs within the United States. Accreditation is accomplished through a peer review process and is based upon established standards and guidelines. Starting in 2005 certified and ACGME recognized fellowships have started in the U.S. to train fellows. The Association of Academic Dermatologic Surgoens has board certified dermasurgeon professors who have faculty appointments at major teaching hospitals and universities and are engaged in training medical students and residents in the practice of dermatologic surgery and Mohs micrographic surgery.