Is Mohs Surgery Right for Me?
Conveniently located to serve Santa Monica
Is Mohs Surgery Right for Me?
Ralph A. Massey, MD — Santa Monica & Encino, CA
Many patients with skin cancer wonder, “Is Mohs surgery right for me?” If you’re considering whether or not to undergo this form of skin-cancer removal in Santa Monica, it’s best to learn more about your options.
Mohs Surgery or Excision?
Mohs surgery and traditional (wide) excision are the two surgical options for removal of a cancerous skin lesion. Both involve numbing using a local anesthetic, followed by removal of the affected tissue. However, beyond that, there are a variety of differences between the two techniques.
The most important difference between Mohs and traditional excision is their success rates. At 98%, Mohs surgery has the highest cure rate of all treatment methods for basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). Standard excision has a 93% to 95% success rate for these types of skin cancer.
Traditional excision surgery involves removal of more normal skin tissue than Mohs surgery. Mohs is specifically designed to be a tissue-sparing technique. With traditional excision, when the lesion is removed, a margin of 0.5 cm to 1 cm of normal tissue around it is also removed.
Traditional excision is often utilized for less-sensitive areas like the torso, arms, and legs. Because Mohs is a tissue-sparing method, it is ideal for use in sensitive areas where conservation of tissue is key. These include areas like the eyelids, nose, scalp, ears, and other regions of the face. It is also often used on the neck, feet, genitals, and hands.
Mohs surgery is a much more thorough method than traditional excision. It removes a layer of tissue, evaluates these tissues under a microscope for the presence of cancer cells, and then removes the next layer and repeats the process. This continues until no cancer cells are present.
Because it is a more thorough method, it takes more time to perform than traditional excision. However, the wait time is reduced, since the tissue evaluation is performed while you wait. Evaluation of tissue after a standard excision can take up to a week.
Mohs surgery is ideal for situations where tumors are large, aggressive, or recurring. Because of this, while Mohs surgery is more expensive than wide excision, it’s generally less expensive than wide excision in the long run due to its improved outcomes.
Mohs Surgery or Radiation Therapy?
Unlike Mohs surgery, Superficial Radiation Therapy (SRT) is a non-surgical and non-invasive option for treatment of skin cancer. Both options offer their own pros and cons.
As with traditional vs. Mohs, there is a difference in cure rates. While Mohs surgery has a 98% success rate with basal cell carcinoma and squamous cell carcinoma, SRT has a 95% success rate.
Because radiation therapy is non-surgical, there are no incisions or scars, and there’s no need for anesthesia, skin reconstruction, or grafts. This also leads to a much faster recovery process.
Additionally, before Mohs surgery, patients may need to avoid certain medications, which is not the case for radiation. Antibiotics will also be required for Mohs surgery but not radiation therapy.
However, Mohs offers a shorter overall treatment process. While a single radiation treatment takes less time to perform, up to 20 treatment sessions may be required, greatly extending the length of the process.
Radiation treatments can also result in issues like radiation dermatitis, scar-tissue growth, photo aging, reduced skin elasticity, and hypopigmentation.
Additionally, with radiation, the odds increase for new cancerous lesions in the treated area. With Mohs, there’s a less than one-percent rate of recurrence.
Mohs Surgery or Another Treatment Method?
Treatment methods like cryotherapy, desiccation and curettage, chemotherapy injections, topical chemotherapy, and laser treatments may also be available.
These are ideal for areas like the legs, arms, and torso. They may also be helpful for elderly patients who are in poor health, since Mohs surgery may not be safe for these patients. Patients who worry about scarring may also prefer these options.
However, it is most important to remember that these methods all have a lower success rate than Mohs surgery. Partial treatment can lead to worse cosmetic issues and other complications.
Mohs for Melanomas and MCC
While Mohs surgery is ideal for treatment of basal cell carcinomas and squamous cell carcinomas, it is not typically the treatment of choice for melanomas and Merkel cell carcinomas. Immunotherapy and wide excision are common treatment options in these cases.
Slow Mohs surgery can be used for melanomas in their early stages, specifically lentigo malignant melanomas. Slow Mohs requires a longer wait for tissue-evaluation results.
Find Out More
To speak with Dr. Ralph Massey and learn whether Mohs surgery in Santa Monica is right for you, contact us today. We will be happy to arrange an informative consultation with Dr. Massey at your earliest convenience.