Skin cancers are generally treated with Standard Surgical Excision or Mohs Micrographic Surgical Excision.
These are the main differences:
Excisional Surgery –Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The defect is typically repaired right afterwards, and the growth is sent to the laboratory to verify that all cancerous cells have been removed.
This type of surgery is used for most melanoma and atypical (dysplastic) mole removals as well as smaller skin cancers; since the procedure is usually quicker, more convenient and allows better pathologic assessment of pigmented lesions.
Cure rates are good; but this requires removal of more tissue as the safety margin (as mentioned above) and are not as high as with Mohs surgery (see below) and the final pathology results are usually not back for several days.
Mohs Micrographic Surgery – The physician removes the bulk of the tumor with a curette or scalpel and then removes very thin layers of the remaining surrounding skin one layer at a time. Each layer is then immediately checked under a microscope while the patient waits; and the procedure is repeated until the last layer viewed is cancer-free. Therefore there is no waiting on pathology results; since the pathology is done with frozen sectioning in the office.
The wound is then typically repaired right afterwards (as with standard excision). This technique saves the greatest amount of healthy tissue and may reduce the rate of local recurrence. It is often used for tumors that have recurred or are in hard-to-treat places such as the head, neck, hands, and feet. It is mostly used for non-melanoma skin cancer (BCC and SCC) but is being used increasingly for melanoma in certain situations and locations.
The main disadvantage is the wait times on the day of surgery; since multiple layers may need to be evaluated to ensure complete but accurate eradication of the tumor. It also requires offices with a certified lab, special equipment and a highly trained Mohs surgeon familiar with the technique to ensure the extremely high cure rates.
Not all Dermatology offices have this capability; but here at ASLC, both of our Dermatologists are highly skilled and trained Mohs surgeons!
Radiation
+Superficial radiation therapy (SRT)- offers an effective in-office non-surgical alternative for treatment of most skin cancers. This can be beneficial for patients who are poor surgical candidates due to age, multiple underlying medical issues or on blood thinners. However, radiation treatment must be fractionated to minimize local side effects and scarring, typically requiring multiple visits to complete a course. Cure rates are also not quite as high as with Mohs micrographic surgery for more aggressive skin cancers.
Other less commonly used modalities:
- cryosurgery
- laser
- photodynamic therapy