Treatment of Skin Cancer
There are two different surgical options to treat skin cancer:
- Wide local excision. This means that a surgeon takes off the skin cancer with a margin of normal tissue. Many types of surgeons do this type of procedure, including General Surgeons, Plastic Surgeons, and Otolaryngologists. This is done in either the office or the operating room, depending on the size of the skin cancer. When wide local excision is done in the operating room, the surgeon may send the tissue to the pathologist for what is called a frozen section, meaning he or she will freeze that bit of tissue and look at it to see if there is any skin cancer left. This doesn’t work well for melanoma, and still isn’t 100% accurate for other types of skin cancer. We only know for sure after the pathologist processes the tissue with chemicals and special stains, which takes a few days.
- Mohs surgery. This is named after the doctor who created it, and is only done by specially-trained Mohs surgeons, who are dermatologists. This type of surgery is done in an office, using numbing medicine. The difference between this and a wide local excision is that the Mohs surgeon first takes out the cancer, then takes out just the rim of the wound and looks at that flat under a microscope himself (as opposed to sending it to a pathologist). This concept is a little hard to explain; this diagram clarifies the procedure. The take-home point is that Mohs surgery takes a little longer, because the surgeon takes the cancer out in multiple steps. But they remove as little normal tissue as possible, because they look at it under the microscope at each stage, and when you’re done with the Mohs surgery you know your cancer is gone.
What About Afterward?
If you have a skin cancer removed, generally the physician who did the procedure will also close the wound. If you have had Mohs surgery, however, the Mohs surgeon may refer you to a Plastic Surgeon for skin cancers on the face. If this is the case, you will often see the Plastic Surgeon before your Mohs surgery, so that you have have the closure done as soon as possible afterward. The reconstructive surgery you have depends on how big the wound is, and where it is location. But options including skin grafting and local rotation flaps. See some before and after pictures below.
Before and After Photos***
***All patient results may vary, these procedures are for cosmetic purposes only and results are not guaranteed, nor are permanent. All patients are different and in no way will any procedures be alike, nor the recovery period.