According to the American Academy of Dermatology, there are over 1,000,000 new cases of skin cancer diagnosed annually. Cancer occurs when abnormal cells in a section of the body grow at an uncontrolled rate and surround or invade the normal tissue. Skin cancer can result from rare inherited diseases, trauma (scars), certain chemicals or superficial x-rays, but the most common association is from long-term exposure to sunlight. This is why body parts which are more frequently exposed to sunlight, such as the face and arms, are more likely to develop skin cancer. The most common types of skin cancer, basal cell carcinoma and squamous cell carcinoma, are named to designate the type of skin cell from which the cancer originates. A less common or rarer type of skin cancer, malignant melanoma, appears as a dark pigmented bump or spot on your body which grows in size.

Basal cell carcinoma is the most common form of skin cancer. This type of carcinoma rarely metastasizes (spreads) to distant areas of the body; however, it will destroy nearby parts of the body as it grows larger and deeper under the surface of the skin. Squamous cell carcinoma behaves locally like basal cell carcinoma. Unlike basal cell carcinoma, aggressive cases of squamous cell carcinoma can spread to other parts of the body.

Basal cell carcinomas and squamous cell carcinomas appear as a small pimple-like bump that begins to grow, bleed, and does not heal. The bumps can be scaly, crusted, red, darker or similar in color to the surrounding skin.

Frequently, what you see when you look at the growth is only a small portion of the tumor. The cancer growth will begin in the top layer of the skin and grow downward, forming fine, thin projections underneath the surface of the skin that are difficult to see with the naked eye. As there are several types of basal and squamous cell carcinoma, a biopsy is taken before treatment to determine the type of cancer it is and which treatment is needed. Both basal cell carcinoma and squamous cell carcinoma are easily treatable if detected early.

Melanoma is cancer of the pigment producing cells of the skin (melanocytes) and is the deadliest form of skin cancer. If you have a mole exhibiting any of the following characteristics you should have it checked by your dermatologist immediately:

A-Asymmetry (one side does not match the other side in shape or size)
B-Borders that are irregular (edges that appear blurred, notched)
C-Color – The mole’s color is not uniform. It may contain black, brown, tan, red, or white colors mottled throughout.
D-Diameter – Typically 6mm or greater in size, occasionally smaller.
E-Evolving – A mole or lesion suddenly develops or changes in size, shape, or color.

Melanomas have traditionally been removed surgically by removing a large area of normal skin along with the melanoma, leading to scarring. Mohs micrographic surgery offers a less invasive and more precise treatment for melanoma. Mohs micrographic surgery is performed as an outpatient procedure which entirely removes the cancerous cells while sparing the surrounding healthy skin.

According to the American Academy of Dermatology, one in five Americans will develop some type of skin cancer within their lifetime. Incidences of melanoma are increasing. The success rate of initial skin cancer treatment exceeds 90 percent provided the cancer is caught early on. Retreatment success rates decrease to below 75 percent. There are several common methods of treatment your dermatologist may choose including curettage and electrodessication (scraping and burning the area with an electric needle), freezing the area (cryosurgery), surgical removal of the growth (excision), or radiation therapy. The treatment chosen depends upon the size of the cancer, the location, the type of tumor it is, and whether or not the area has had prior treatment. Mohs surgery may be performed after trying any of the above methods, and is typically performed on cancers that are difficult to treat with other therapies or if the skin cancer is recurrent.

Mohs surgery is a special surgical procedure that removes the cancerous tissue while sparing healthy surrounding tissue. Mohs surgery is a three to four step process:

1) Excision of the cancerous tissue (called a “stage”).

2) Lab processing. Using our in-house laboratory, the initial section of the biopsied tissue is taken, processed and mounted onto a slide by the histologist.

3) Evaluation of the tissue by the Mohs surgeon. Dr. Hu reviews the slide and determines if all of the cancer has been excised. If the tissue is clear, your wound will be sutured up and your surgery is complete.

4) New Excision. If, after the histological examination, cancer still remains, an additional rim of tissue is removed until all of the cancer is cleared. Reconstruction of the excised area is undertaken once the final stage of tissue is cancer free.

On the day of your surgery, check in with our front desk staff who will escort you to the Mohs patient waiting room. Your surgery starts when you are taken into the procedure room. If this is your first visit with Dr. Hu, a medical assistant will explain the procedure to you, review your patient questionnaire, and answer any questions you may have. Dr. Hu will also be available to answer questions if needed.

The area around your skin cancer will be anesthetized. You may feel a brief stinging sensation which will quickly fade. Once the area is completely numb, Dr. Hu will typically remove the cancerous tissue in two equal sections. Typically the first area of tissue removed is the size of a penny. Larger cancerous growths may require a larger size of tissue removal. The tissue will be diagrammed by Dr. Hu and then sent to our lab to be processed.

A medical assistant will apply a pressure dressing over the surgery area, and you will return to the Mohs patient waiting room while your slide is processed. It can take up to an hour for your slide to be processed and examined. While you wait, you can read, rest, or even work on a knitting project. Coffee, tea, and snacks will be made available to you at this time.

Commonly, you will need at least two to three stages of Mohs surgery before all the cancer has been removed. For each stage, you will be taken back into the procedure room, re-anesthetized, and another layer of tissue will be removed and checked for cancerous cells. Most Mohs surgeries are completed in one day; however, you may be asked to return for a second surgery day if needed. After your surgery, Dr. Hu and her staff will review proper surgical wound care with you and discuss any further concerns you may have. You will also be given an after hours emergency telephone number should any issues arise after normal office hours.

Pain

Our patients have found that they experience very little pain or discomfort after surgery. If you do have pain, use Tylenol or a non-aspirin pain reliever. Do not use aspirin as it can promote bleeding. If necessary, a stronger pain medicine can be prescribed.

Bleeding

You may experience a small amount of post-operative bleeding. To stop the bleeding, place a gauze pad over the bleeding point and hold it there with a light but constant pressure for 20 minutes. After 20 minutes have elapsed, check the area. If it is still bleeding, repeat the pressure for another 20 minutes. If the bleeding does not stop, call our office. We can be reached at (520) 382-3346 from 8:30am to 5:00pm Monday through Friday, or you can call our on-call staff person at (520)334-5609 after hours. If you are experiencing an emergency and are in distress, call 911 immediately.

Complications

It is normal for the tissue around your wound to develop a small amount of redness, itching, swelling and bruising. If the redness spreads or persists for more than two days, or your wound begins to drain pus, call us immediately. If you experience itching in the areas where adhesive tape has been applied, ask your pharmacist for non-allergenic tape and call our staff or inform us at your next visit. Swelling and bruising should subside after four to five days post surgery. You can use an ice pack in the first 24 hours to help decrease the swelling.

Numbness

Numbness in the area surrounding your surgery site can persist for several months or longer. Occasionally, the numbness is permanent. If you experience numbness, please discuss this with Dr. Hu at your next visit.

Follow-Up Care

You will continue to see Dr. Hu until your wound is healed, and then return to your referring dermatologist for further care. You are advised to schedule a skin check with your dermatologist every six months for two years after having Mohs surgery. After two years, provided there are no reoccurrences, you should see your dermatologist annually. If you have not yet established a relationship with a dermatologist, our staff will be happy to refer you to one of our excellent on-staff dermatologists.

Mohs surgery tends to result in minimal scarring, and you can assist in reducing scarring by properly caring for your wound. Our staff will discuss wound care with you in detail and provide you with literature detailing proper wound care for your review at home. Dr. Hu has extensive training in skin reconstruction, and we also offer laser treatments for the best cosmetic outcome post operatively.

Once you have been diagnosed with skin cancer, the probability of developing another skin cancer is higher. Sun damage to your skin is irreversible, but you can take measures to prevent future damage. Apply a sunscreen at least 10 minutes before going outside. Even if you are not planning on staying outside, a drive in the car can be enough to lay the foundation for further damage. We recommend you use a sunscreen with an SPF of 30 or higher, wear long sleeved shirts/pants, a wide-brimmed hat, and other protective clothing. Avoid excessive outings in the sun. Performing regular self-checks can help detect cancers sooner and should be an important part of your routine.