Skin cancer is the most common cancer in the United States, with more than one in five Americans developing it by age 70, according to the Skin Cancer Foundation. For patients who develop cancer in cosmetically sensitive areas—such as the head, neck, or hands—a special type of surgery called Mohs may be the best option.
Compared with other types of skin cancer surgeries, Mohs surgery provides the highest possible cure rate with the smallest amount of skin removal. With Mohs, a surgeon numbs the affected area, removes the cancerous tissue, and immediately analyzes it.
The pathology-trained surgeon examines the entire cut edge. If any cancer remains, another small amount of tissue is removed. Because the process is precise, the surgeon can remove less skin and still find all cancer cells.
Each removal and analysis is called a “stage.” It typically takes one to two stages before all traces of the cancer are removed. However, in some circumstances, more stages are necessary. As a Mohs surgeon at Vancouver Clinic, I’ve performed up to 16 stages, but those cases are rare.
Mohs is appropriate for basal cell and squamous cell cancers in high-risk zones, such as the nose, lips, and ears, and medium-risk zones, such as the scalp, forehead, cheeks, hands, feet, and genitals. It is also appropriate for a number of other skin cancers. These cancers may need to be above a certain size.
The procedure itself is minimally painful. The outside layer of the skin is the most sensitive, so the first numbing shot is the most uncomfortable part. Most patients use acetaminophen to manage any pain during recovery. Healing takes about a week on the head and neck, and a little longer on the legs.
As a dermatologist, I find it extremely gratifying to do Mohs procedures—and not just because I get to send patients home cancer-free. Each person’s skin and muscles move differently, which means each person needs a slightly different approach in reconstruction. It’s my job to understand how to best reconstruct a wound to minimize scarring, preserve function, and achieve a great cosmetic result.
What’s more, because patients are awake, I get to talk to them and calm their anxieties. I’ve learned so much about people and their interests, families, professions, and approaches to life. In June, Vancouver Clinic opened a dedicated space for Mohs surgery at Gateway Salmon Creek. The new suite makes the experience even more efficient and comfortable for patients. The waiting area features large windows and a beautiful view of our Northwest trees, creating a comfortable and calming environment. Behind the scenes, providers and staff have access to a large, well-equipped lab. In the future, the space should allow us to offer Mohs surgery for invasive melanoma, which is the new frontier of Mohs surgery.
Of course, while a great Mohs surgery experience is wonderful, reducing your skin cancer risk by practicing sun safety is better. Strive to avoid the noontime sun, wear sun-protective clothing, use a hat, and wear sunscreen during every season. If you have questions about Mohs surgery or skincare, or are just in need of a skin exam, be sure to talk to your primary care provider or dermatologist.
Dr. Zheng Qian is a dermatologist and Mohs surgeon at Vancouver Clinic. He enjoys giving patients the knowledge they need to take care of their skin now and in the future.