When Pat Parnell was told the scar that was slowly growing across her face was basal cell carcinoma, or skin cancer, she was a little nervous about going in for surgery.
Her husband had melanoma taken from his face a year before and the process had taken weeks of cuts, surgeries and anxious waiting. But Parnell was in for a surprise. Her dermatologist at English Dermatology in Ahwatukee Foothills sent her to a Mohs Surgeon.
She made an appointment and the surgery was done in two and a half hours. Just over two weeks later she said no one could even tell surgery had been done.
“My husband was with me for the whole two hours,” Parnell said. “The days of waiting in between, not knowing if you’re going to be cut on again, it was very stressful for him. I was awake the whole time and when I walked out the door I knew the cancer was gone. It was such a difference.”
Mohs Surgery isn’t something used for all types of skin cancers, though it has been used for many. It’s most commonly used to treat basal cell carcinoma and squamous cell carcinoma.
It’s a technique used by specially trained surgeons that helps preserve more tissue and save the patient from unnecessary cuts. Mohs has a higher success rate than most conventional methods and is done while the patient is awake.
It was developed by Dr. Fredric Mohs in 1935 when he was a medical student. At the time he began using a chemical to preserve tumor cells so they could be sliced carefully and examined under a microscope.
The technique was perfected in laboratories and eventually a student of Mohs discovered that the chemical wasn’t necessary but it was the technique that was the secret to success.
“Visualize a tumor being like a loaf of raisin bread,” said Dr. William Kivett, board certified dermatologist and plastic surgeon for English Dermatology. “Conventional methods, which are still used today, will take the piece and a pathologist will slice seven slices out of something the size of a nickel. That’s seven small slices but there could be another 500 slices that could be taken. If you slice and you miss the raisin, the raisin, or the tumor, could still be there. These seven slices are tumor free so they say, oh it’s tumor free. Well, what if they missed the raisin?
“What Dr. Mohs did was he said I don’t care what’s above, all I care about is what’s on the bottom or the sides, against the patient. So he took the piece and flipped it over and instead of doing what’s called a bread loaf slice he took a slice at 90 degrees. He took a thin slice all the way across the bottom and the sides in one piece.”
With a Mohs Surgery that small sample taken from the skin is processed under a microscope while the patient waits. If no tumor is found, the process is over, but if a tumor is found the surgeon will take another thin shave of the tissue and process it over again until it’s gone.
“You’re removing less tissue, thinner sections, shorter period of time, looking at it immediately and then if there’s a tumor present in some areas, only in those tiny areas do you take a second section or third or forth or fifth,” Kivett said. “The worst part about Mohs Surgery is the boredom. I always tell people to bring a book and a snack. We mark it off. We take a very thin shave of tissue. We put a dressing over it and it takes about 40 minutes to process.”
Kivett said Mohs has gained a lot more popularity in the past three or four years, but that it takes a lot of additional training to be able to do. A surgeon must also be a pathologist to be able to view the tumor in a microscope and make a decision to take more tissue or not. Most pathologists in hospitals have their own way of removing tissues and for a lot of tumors, those methods work fine.
Once a tumor is removed, treatment of the wound varies. Mohs Surgery is only about removing the tumor. Kivett is one of a few surgeons in the country who is board certified in plastic surgery and dermatology so he can do the surgery and the reconstruction.
The American Society of Mohs Surgery, the American Academy of Dermatology and the American College of Mohs Surgeons all have resources for finding Mohs Surgeons. For more information on English Dermatology in Ahwatukee Foothills, 15215 S. 48th St., visit englishdermatology.com.
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