24 Aug Mohs Surgery for Skin Cancer: A “New” Procedure Nearly 100 Years Old
Anyone who has been diagnosed with skin cancer knows that waiting for biopsy results is the toughest part. That’s why Spectrum Dermatology is one of the few practices in the area that offers Mohs surgery, allowing patients to get an “all clear” from biopsies in a single appointment. In the past, the standard protocol for treating early stage skin cancer included several appointments and multiple biopsies. The goal of this slow but steady approach was to minimize scarring by only removing small areas of the cancerous area. These biopsies were then sent to a lab, often out of state, to see if the biopsy had cancerous areas that touched the border—if the tissue sample had abnormal cells at the border, then another biopsy was necessary. This was repeated until no cancerous cells touched the tissue sample border.
There has also been another standard, much more aggressive approach. Rather than take small biopsies and have them tested, some dermatologists took large biopsies in order to increase the odds of having an “all clear border.” This certainly helped reduce the number of required biopsies and patient appointments, but at the cost of sometimes very large and unsightly incisions. Oftentimes, a small cancerous mole required the removal of one square inch of skin.
Mohs surgery for skin cancer removal has changed everything, but it’s far from a new procedure.
A History of Mohs Surgery
The Mohs technique was invented in the 1930s by a general surgeon. Dr. Frederic Mohs was researching injectable irritants at the University of Wisconsin to check for inflammatory responses in rat cancers. He found that a zinc chloride solution led to tissue necrosis in both normal tissue and tumors. With further investigation, he discovered through a microscopic examination that the necrotic tissue presented a well-preserved histology of the same, just as if the tissue had been removed and placed in a solution. This realization is the foundation for today’s understanding that cancerous tissues need to be removed using total microscopic control. For more than ten years the fixed tissue technique was used, and for many of those years Dr. Mohs was the sole practitioner.
Dr. Mohs and, later, his peers followed up with patients who underwent this technique years after their excisions. These follow-ups showed that the Mohs method was highly effective. There was a further breakthrough in 1953 when a patient had an eyelid carcinoma removed. However, the carcinoma involved a margin found in the first level, which led to the need to use horizontal frozen sections for following levels. Known as the fresh tissue technique, it led to great results and Dr. Mohs adopted it for treating eyelid cancers moving forward.
History in the Making for Skin Cancer Treatment
The fresh tissue technique was used 66 times for basal cell and squamous cell carcinoma between 1953 – 1969, resulting in 100% cure rates five years later. Mohs used corroborating data to urge the larger medical community to validate the fresh tissue technique, which in 1969 still hadn’t been adopted from his original fixed tissue technique. Today, the most common approach is the fresh tissue technique, though in some cases the fixed tissue technique is still used.
Dermatologists remain the primary practitioners of the Mohs technique, and Mohs training was in high demand starting in the 1950s. The original training sessions lasted many months and primarily happened at the Mohs’ Chemosurgery Clinic, followed by “second generation” dermatologists passing the technique on. The American College of Chemosurgery was founded in 1967, and in the 1970s dermatology residency programs offered specializations in Mohs surgery. The 1980s saw the sponsorship of Mohs surgery by the American College of Chemosurgery, whose name was changed in 1986 to the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Today, it is the American College of Mohs Surgery.
Why Isn’t Mohs Surgery More Available?
All dermatology residency programs today require some Mohs surgery training. This is especially important as skin cancer rates rise. However, Mohs surgery at a dermatology practice requires an on-site lab, which is an expense that many clinics simply don’t prioritize. Mohs surgery entails a patient requiring just one appointment, and smaller samples of tissue are repeatedly removed and tested on site until the borders are “all clear.” It’s obviously the best approach for the patient who wants to minimize the number of appointments and scarring, but it’s a big undertaking for many dermatology clinics to take on.
Spectrum Dermatology offers Mohs surgery because we put the patient’s safety and comfort first. To learn more about Mohs surgery, contact the office today at (480) 948-8400.