Micrographic Dermatologic Surgery

Skin cancers are the most common form of cancers that humans develop in their lifetime, and they usually occur in the most sun-exposed areas, including face, scalp, ears, neck, arms, and legs, but even genital areas can be at risk. Fortunately, a precise and complex process where small amounts of skin are removed and analyzed microscopically step-by-step can result in complete cancer removal and cure.

Micrographic Dermatologic Surgery was first developed in the 1950s by Dr. Frederick Mohs for this purpose and has been modified and improved with the introduction of special tissue stains to help identify cancer cells as well as plastic surgery reconstructive techniques to minimize scarring and rebuild damaged areas of involvment where needed. It is a true team effort, involving specialized histotechnicians, expertly-trained medical assistants, and a uniquely qualified dermatologic surgeon with years of training in histopathology and plastic surgery reconstruction.

Jennifer Baron, M.D. is a Mohs surgery specialist in San Jose, California. Dr. Baron and her caring and experienced team provide same-day treatment in her nationally-certified surgery clinic.

The Mohs surgery difference

Because skin cancers usually grow close to the surface, it might appear that they can just be cut away. With standard skin cancer excision surgery, your doctor does cut away what looks like cancer in addition to a thick "margin" of healthy skin surrounding the area according to a standardized protocol. The tissue is sent away to a lab for a few days of processing and simplified testing in the hopes that all cancerous cells are captured. During this time you wait and wonder if it has been cleared. Since your doctor can't be sure right away if the cancer is gone, you will not have the opportunity for reconstructive repair of the "hole" or area of removed skin for a delayed period, or, you will have a simple repair done in case the area needs additional surgery later.

Non-surgical methods are also used in some cases, including chemotherapy creams or injections, ionizing radiation ("brachytherapy"), ultraviolet radiation ("phototherapy"), and scraping off the surface ("currettage"). Not one of these methods ensures that all of the cancer is removed, and many cancers (over 30%) recur within 1 - 5 years if not treated with Mohs. In fact, the radiation methods add an additional risk of new cancers developing in the treatment areas due to the effects of radiation itself.

With Mohs surgery, the principle is very straightforward. Small, tissue-sparing portions of skin are carefully removed in the area of the original biopsy that showed cancer. Dr. Baron orients this small piece of skin and marks it with special inks then hands it to her Mohs-trained technician to flash-freeze it and lay it onto glass slides. After processing it with special stains to pick up even one single cancer cell, the slides are handed back to Dr. Baron who examines the entire surface perimeter and deep margin under her Olympus BX41 microscope. If Dr. Baron sees cancer cells in portions of the tissue, she indicates the areas of involvement and calls you back in for additional removal in those areas only. She does not have to remove a large area of healthy, normal skin, only the area(s) that have "roots" or extensions of cancer cells. This is what makes Mohs so valuable in areas such as the eyelids, nose, ears, genital areas, hands, and really, anywhere. 

Are you a candidate for Mohs surgery? 

There is a well-defined list of skin cancer types, including primary and recurrent basal cell, squamous cell and more uncommon carcinomas, melanoma in situ, and some rare skin sarcomas as well as a prioritized location on the body that determines whether Mohs surgey is the best treatment. Several national and international cancer committees have established these guidelines so that the highest-risk and functionally- and cosmetically-compromised areas are at the top of the list for treatment with Mohs.

Benefits of Mohs surgery

Perhaps the most reassuring part of Mohs surgery is that there’s no extended-day wait for results. You know at the end of your treatment day that all cancer cells have been identified and removed and the wound has been expertly repaired for full recovery. 

Mohs surgery means that you’ve lost as little healthy tissue as possible while achieving the highest cancer clearance rate available. After the cancer is removed, your skin will occasionally be allowed heal naturally without additional treatment. However, in most cases, Dr. Baron will need to utilize her complex surgical skills to provide you with the best functional and cosmetic outcome. Expert bandaging and simple wound care instructions are provided, and your stitches will be removed in 6 - 7 days.

To find out more about Mohs surgery and its suitability for you, call our office for consultation with Dr. Baron. Call the office at 408-329-6056 to make an appointment today or schedule your Mohs surgery and Dr. Baron and her staff will be sure that all of your questions are answered on the day of treatment.