Okay, so you have a skin cancer,
and it's on a location of high cosmetic importance like your head and neck. And you're kind of thinking, "How am I going to treat this?"
"What does it mean for me, and what are my options?" And guys, we have a lot of really good videos on not only the
diagnosis, whether it's a basal cell or squamous cell or something else,
but we also have the treatment videos, and this treatment video is going to talk about Mohs.
Now Mohs micrographic surgery is named after Frederick Mohs, who invented this amazing procedure
back in the 60s to try to remove cancers with an enormously high cure rate, somewhere between 97 and 99 percent.
Which is awesome. To try to remove those cancers and keep the hole as small as possible,
so that the outcome or the scar that you're left with is as good as possible.
It kind of makes sense. If we can have a procedure that has
97 to 99 percent cure rates, and the hole is very small, then that means that how we
reconstruct the area should be smaller, because the hole isn't as big, which means your outcome should be better.
So what happens with Mohs? Well Mohs is a procedure that happens over time.
So it's not like you come in to the office, we numb it, we cut it out and you're out the door in 20 minutes.
With that procedure, that excision which we have videos on,
what happens is that tissue gets put in a bottle and sent off to a lab, and then we get the results back days,
or maybe a week later. And if we didn't get around all of the tissue,
then we need to have you come back in, and we cut it out and take more.
And so for that procedure, since we don't have immediate lab diagnosis,
we tend to take a bigger margin to clear it.
Kind of makes sense.
If I'm not quite sure, I take a little bit more. And so a general excision is
really good for things where there's lots of skin, and I can take a bigger margin, which means a bigger scar, like maybe the body.
But let's say you have a cancer on your face, and we need to keep that hole as small as possible.
That means that we need immediate lab diagnosis for that procedure, and how we do that is with Mohs
micrographic surgery.
So you'll come back into the room. We'll numb it locally, and then we'll cut an area out about one to two millimeters
outside of what our eyes can see
the cancer being. So what we have here is a squamous cell cancer that's been previously biopsied. I'm going to clean it with some alcohol.
So you can see right here...
That is about the area...
Well, one point two centimeters,
and I'm going to go just to the outside of this line, so that I can give a couple millimeters of
margins, so I'm actually gonna be taking out one point four. If it's clear,
then we're gonna close it with something that looks like this.
That doesn't look too bad to close. But if we were gonna do this with a surgical approach with an excision,
we would need to take five millimeter margins, which would bring it out to about right here
for both, and then that would result in a closure
that is approximately something like this.
Now the difference between closing that and closing this on an area
that's tight, that is a big, big difference.
So Mohs allows us, Mohs micrographic surgery allows us to keep the hole as small as possible.
Which theoretically means a smaller scar, and that
theoretically means a better cosmetic outcome. And the clearance rate for a Mohs is somewhere between 97 and 99 percent.
Clearance rate for an excision, if we were to just excise it, is somewhere around 90 percent.
Now here comes the poke and the burn.
Ouch, ouch.
And we're numbing this whole area.
So again, we're going to go to the outside of this line,
and then we're going to mark the tissue that we're removing as well as the skin.
So we're going to put a little mark there.
A little mark here.
Little mark here.
And a little mark there. And then when we take it to process, what we're going to do is, we're gonna
dye all these with different dyes, so that if there's just a little bit of cancer here, we can chase it that way.
If there's cancer in the whole thing, we'll go around the whole area.
I'm trying to get around
the area as
much as possible,
because the goal is
to remove all the cancer,
and then we process it. So we take it into the lab and then they freeze it, and they cut it into very thin sections.
They mount it on slides. They stain the slides, and then the doctor reads the slides.
Now all of that processing takes about one hour.
So you're waiting in the lobby.
You'll have a bandage on, but you'll be waiting in the lobby for us to process the slides, and then you get brought back into
the room. And if we got all the cancer,
awesome. Now we decide on how to close you up to give you the best cosmetic appearance.
But if we didn't get all the cancer, then because the doctor has looked at it under the microscope,
they will know the directionality that the tumor is going, and then they chase it.
It's like a heat-seeking missile, and we just follow the cancer and we eradicate it.
And we keep doing this process until you don't have cancer there anymore. And then we close you up and then you go home.
Okay, so we've removed the cancer, and we have clear margins. So now we are sewing it up.
So we're just going to extend this down.
Now this is a lower leg, and lower legs take a long time to heal.
So we're going to leave the stitches in
for
probably 14 days.
So the difference between an excision and
Mohs micrographic surgery,
is that an excision takes bigger margins, and is used on areas of the body that have more skin to pull together, and aren't as high
cosmetic, or
functional importance.
Mohs keeps the hole as small as possible, has a very high cure rate, and then hopefully has the cosmetic outcome be as good as
possible.
Now with both an excision and with Mohs,
you usually come back seven to maybe twenty-one days later to have the stitches removed. And we have videos on
post-operative care that are basically the same for an excision or for Mohs.
So you're sitting there going, "Okay Reagan, uhhh, my doctor told me I should have an excision.
Should I have Mohs?"
Or... "My doctor told me I have Mohs, but I don't really think I should, I think I should have an excision.
What do I do?" So number one, get your pathology report, and look to see what type of cancer you have.
Is it a basal cell cancer?
And then look further, is that basal cell cancer superficial, because it'll say superficial basal cell cancer, or does it have depth to it?
Which means something like nodular or infiltrating or sclerosing or morphia form, or any of these terms.
And then go to the American Academy of Dermatology website, and we're gonna put the link down below,
and they have an app that you can for free put on your phone, and it'll walk you through barney style,
where the area is, what type of cancer it is, about how big it is, and it will tell you if Mohs is appropriate.
So if your doctor has recommended an excision for something where Mohs is appropriate, just ask them.
They probably have a really good reason for doing it.
And if your doctor recommended Mohs, and it's not on the appropriate use criteria from the AAD, then ask them.
They probably have a good reason for why they're recommending Mohs when it doesn't seem to fit in the typical Mohs scenario.
The whole point of this is that your local dermatologist is there for you, to help you become comfortable in your skin.
Which means we got get rid of these cancers.
We got to get rid of them as soon as reasonably possible, and after we've gotten the cancer gone,
we need to focus on giving you your cosmetic appearance back, and making sure the
function of the area is where it needs to be. So please watch these videos.
Please talk to your local dermatologist, and most importantly, please make sure you're not only comfortable with, but that you also
understand what's about to happen.
Patient: The Mohs procedure I think has been a godsend. I don't know how long it's been around, but it certainly has
helped me. The Mohs procedure that you've performed,
I was very comfortable with. I knew what a Mohs procedure was.
And I knew that it might be two or three attempts to clear the margins.
But I also knew that when you were finished, and said they were clear, I could count on that. You're able to
determine the the margins
right away or
within an hour, and that's a big deal for the patient.
Dr. Anderson: Thank you so much for watching this video.
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