HOME WEB NEWS IMAGES CLASSIFIEDS YELLOW PAGESPOLLS - SURVEYS WIKI COUNTRIES PHOTOS US UK INDIA
Cities Stocks Weather Movies Coupons Travel Blogs Health Horoscope Maps ASIA EUROPE Classifieds Yellow Pages
|
Mohs Surgery, created by a general surgeon, Dr. Fredrick E. Mohs, is microscopically controlled surgery that may be used for the most common type of skin cancer, basal cell carcinoma. There is no statistical difference in recurrence rates between Mohs surgery, and an ordinary surgical excision Lancet 2004 Nov 13;364(9447):1766 and as Mohs surgery is much more expensive it is not recommended for the treatment of basal cell carcinoma. Squamous cell carcinoma is thought to have a lower recurrence rate if it is treated with Mohs surgery rather than a standard surgical excision. In certain areas, especially the nasal tip, nasal ala, and the eyelids, radiation therapy can preserve viable tissue and result in better cosmetic appearance than Mohs surgery (See figure I, demonstrating the bilobed transposition flap with resulting visible scarring)
Contents |
Mohs surgery is performed in four steps:
After each surgical removal of tissue, the specimen is processed (look here for a clay animation of tissue processing), cut on the cryostat and placed on a slides, stained with H&E and then read. If cancer is found, its location is marked on the map (drawing of the tissue) and the surgeon removes the indicated cancerous tissue from the patient. This procedure is repeated until no further cancer is found.
The mapping combined with the unique "smashing the pie pan" method of processing is the essential of Mohs surgery. If one imagines an aluminum pie pan as the blood covered surgical margin, and the top of the pie is the crust covered surface of the skin - the goal is to flatten the aluminum pie pan into one flat sheet, mark it, stain it, and examine it under the microscope. The mapping is simply how one stains and labels the sections for a microscoping exam. The sections can be processed in one piece (using relaxing incisions at multiple points, or hemisectioned like a "Pac-Man" figure), cut in halves, cut in quarters, or cut in multiple pieces. Single piece processing is acceptable for small cancers, and multiple piece sectioning facilitate processing and prevent artifacts. Single piece sectioning prevent errors introduced by soft hard to handle tissue, or from accidental dropping or mislabeling of specimen. Multiple sectioning prevent compression artifacts, separation of tissue, and other logistical problems with handling large thin sheets of frozen skin.
Photos courtesy of Dr. B. Cowan
CASE STUDY 1: Left Nasal Rim Skin Cancer
Mohs surgery case study 1.png
Click to view complete slide-show and the surgeon\'s comments for the Left Nasal Rim Skin Cancer case study
CASE STUDY 2: Right Lower Lip Skin Cancer
Mohs surgery case study 2.png
Click to view complete slide-show and the surgeon\'s comments for the Right Lower Lip Skin Cancer case study
CASE STUDY 3: Left Temple Basal Cell Cancer
Mohs surgery case study 3.png
Click to view complete slide-show and the surgeon\'s comments for the Left Temple Basal Cell Cancer case study
The Board of Medical Subspecialities considers Mohs micrographic surgery as part of the field of dermatology and does not recognize it as a separate subspeciality.
The American Academy of Dermatology is the largest organization of board certified dermatologists, many of whom perform dermatologic and Mohs micrographic surgery. With a membership of over 15,000, it represents virtually all practicing dermatologists in the United States and Canada and has specific member information regarding those performing Mohs micrographic surgery.
The American Society for Dermatologic Surgery founded in 1970 is the largest organization of board certified dermasurgeons with over 5000 members who perform dermatologic surgeries including Mohs micrographic surgery.
The Association of Academic Dermatologic Surgoens has board certified dermasurgeon professors who have faculty appointments at major teaching hospitals and universities and are engaged in training medical students and residents in the practice of dermatologic surgery and Mohs micrographic surgery.
Originally, Dr. Mohs used an escharotic agents made of zinc chloride and bloodroot (contains the alkaloid sanguinarine that is derived from the root of the plant Sanguinaria canadensis). This paste is very similar to "Hoxsey\'s paste". Harry Hoxsey, a lay cancer specialist was developing a herbal tonic and paste designed to treat internal and external cancers. Hoxsey recommended applying paste to the affected area and within days to weeks, the area would necrose (cell death), separate from surrounding tissue and fall out. Dr. Mohs applied a very similar paste after experimenting with a number of compounds to the wound of his skin cancer patients. They were to leave the paste on the wound overnight, and the following day, the skin cancer and surrounding skin would be anesthetic, and ready to be removed. The specimen was then excised, and the tissue examined under the microscope. If cancer remains, more paste was then applied, and the patient would return the following day. Later, frozen section histopathology and local anesthetic allowed the procedure to be performed the same day, with less tissue destruction, and similar cure rate. The term "chemosurgery" remains today, and is used synonymously with Mohs micrographic surgery.
Mohs surgery can be applied to any relatively non-aggressive locally invasive tumors with contiguous growth pattern (i.e. no skipped growth, or metastasis). Today, most Mohs procedures are performed by dermatologists. However, pathologists, plastic surgeons, and otolaryngologists have been trained and are ulitizing Mohs surgery in their practice as well.
This article is licensed under the GNU Free Documentation License. It uses material from Wikipedia
