A small fragment of skin from the suspected cancer is removed and examined under the microscope. Once the biopsy results have been obtained, the best method of treatment can then be decided upon.
Curettage and Electrodesiccation
In this treatment, your provider removes the cancer by scraping it with a long, thin instrument with a sharp looped edge on one end (called a curette). The area is then treated with an electric needle (electrode) to destroy any remaining cancer cells. This process is often repeated once or twice during the same office visit. Curettage and electrodesiccation is a good treatment for superficial basal cell and squamous cell cancers. This procedure is quick and can be performed in your doctor’s office. It can be used to treat several lesions in one visit.
A circular or “football-shaped” incision is made around the cancer. By removing a wide border of normal tissue, the doctor is trying to include any roots or extensions of the cancer that cannot be seen with the naked eye. The skin removed during the surgical excision is then examined under the microscope to assure that all of the cancer has been removed.
Mohs Micrographic Surgery
What is Mohs surgery?
Mohs surgery is a specialized, highly effective technique for removing skin cancers. It was developed in the 1930’s by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete micrographic examination of the removed cancer tissue so that all roots and extensions of the cancer can be found and eliminated. Mohs surgery has the highest reported cure rate of all treatments for skin cancer.
Treating all skin cancer with Mohs surgery is not necessary. Mohs surgery is reserved for skin cancers that have grown back again after previous treatment, are at high risk for recurring, or which are located in cosmetic areas where preservation of the maximum amount of normal skin is important.
Both Drs. McTigue and Chen have had extensive training and experience in skin cancer management and dermatologic reconstructive surgery. Dr. McTigue has been performing Mohs surgery for more than 40 years and has completed over 40,000 cases of Mohs Micrographic surgery. She is certified by the American Board of Dermatology and the American Society of Mohs Micrographic Surgery. Dr. Chen completed rigorous fellowship training in Mohs micrographic surgery and is board¬-certified in both dermatology and micrographic dermatologic (Mohs) surgery by the American Board of Dermatology. She is a member of the American College of Mohs Surgery. Dr. Chen gained extensive experience with melanoma and Merkel cell carcinoma, as well as the more common types of skin cancer, at the University of Michigan and Saint Louis University prior to joining Dr. McTigue at DCSI.
Why remove skin cancers with Mohs surgery?
Some skin cancers are deceptively large, being far bigger under the skin than they appear to be from the surface. These cancers may send out roots in the skin or along blood vessels, nerves, or cartilage. Also, skin cancers that have grown back again after previous treatments may send out extensions deep under the scar tissue that has formed. Mohs surgery is specifically designed to remove these cancers by tracking down and removing these cancerous roots.
How is Mohs surgery done?
There are three steps involved in Mohs surgery
- The skin is first made completely numb using a local anesthetic. The visible cancer is removed along with a thin layer of additional tissue. This takes only a few minutes and the patient may then return to the waiting room. A detailed diagram (called a Mohs map) of the removed specimen is drawn.
- The specimen is then carefully divided and color coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. The slides are placed on microscopic slides and stained for examination under the microscope. This is the most time consuming part of the procedure, often required an hour or more to complete.
- The Mohs surgeon carefully examines these slides under the microscope. This allows her to examine the surgical margin of the removed tissue. In other words, the entire undersurface and the complete edge of the specimen are examined. All microscopic roots of the cancer can thus be precisely identified and pinpointed on the Mohs map.
If more cancer has been found on the microscope slides, your surgeon will use the Mohs map to remove addition tissue only where cancer is present. This is what allows the Mohs surgery technique to leave the smallest possible surgical defect, because there is no guess work involved in deciding where to remove addition tissue. Only tissue around the roots and extensions of cancer is removed.
Please explore the below links to access more information and videos about Mohs surgery from the American Society for Dermatologic Surgery:
How long does it take?
Most cases can be completed in three or fewer stages, requiring less than four hours. However, no one can predict in advance how extensive a given cancer will be, because the size of a skin cancer’s root cannot be estimated in advance. We therefore ask that you reserve the entire day for surgery, in case additional surgical sessions are required.
Will it leave a scar?
After skin cancer is removed and the surgical area has completely healed, there will be a scar. However, Mohs surgery requires the smallest possible amount of tissue removal which leaves the final scarring as minimal as possible. When possible, the site is left to heal naturally which usually results in minimal scarring. For wounds that require reconstruction, Mohs surgeons do everything they can to hide even the longest scars in natural skin lines which are minimally noticeable at a social distance.
What happens after Mohs surgery is completed?
When the cancer is removed, your Mohs surgeon will discuss with you your options. These may include:
- allowing the wound to heal naturally, without additional surgery
- immediate repair of the wound by your Mohs surgeon
- referring you to another surgeon for wound closure.
Will I have pain, bruising, or swelling after surgery?
Most patients do not complain of significant pain. If there’s any discomfort, Tylenol is usually all that is necessary for relief. However, be assured that stronger pain medications will be prescribed when needed. You may have some bruising and swelling around the wound, especially if surgery is being done close the eyes.
Will my insurance cover the cost?
Most insurance policies cover the cost of both Mohs surgery and the surgical reconstruction of the wound. Please check with your insurance carrier for exact information relating to your surgery. Both Drs. McTigue and Chen accept accepts Medicare assignment for cancer surgery.
How do I prepare myself for surgery?
Get a good night’s rest and eat normally the day of the surgery. If you are taking prescription medication, continue to take them unless otherwise directed. However, avoid taking any medication containing aspirin for ten days before your surgery. Also please do not take any aspirin substitutes, such as Advil, Motrin, Nalfon, Naprosyn, etc. within 24 hours of surgery. You may, however, take Tylenol at any time before surgery. You may want to bring a book or magazine, with you to occupy your time while waiting for your slides to be processed and examined. Also, we recommend that you arrange for someone to drive you home after surgery is completed.