With more than 1.3 million new skin cancers diagnosed in the United States each year, treatments have evolved to provide potentially higher cure rates and improved cosmetic results. Mohs surgery at our Thousand Oaks practice represents a significant advance in the treatment of skin cancer.
Mohs micrographic surgery is a complex, specialized technique for the treatment of difficult or recurrent skin cancers. This procedure differs from all other types of surgical procedure in that one person acts as surgeon and pathologist and 100% of the surgical margins are examined microscopically. As a result, according to the scientific literature, cure rates frequently are higher and healthy tissue surrounding the skin cancer is preserved.
To learn more about Mohs surgery in Southern California, click here to request a consultation with one of our providers. Or you can call The Center for Dermatology Care at (805) 497-1694 and one of our helpful staff members will schedule your appointment.
Mohs Surgery Training
First described in the 1930s by Dr. Frederic Mohs, the procedure was modified in the 1970s by doctors at University of California San Francisco. With changes to the procedure and increases in the incidence of skin cancer, Mohs surgery has become one of the fastest growing medical treatments in recent years.
The American College of Mohs Surgery (ACMS) was founded by Dr. Mohs in 1967 to advance research, education and training for skin cancer treatment and reconstructive surgery. Dr. Kaufman has completed ACMS-approved fellowships, which means they have attained the highest level of Mohs surgery qualification available. His elite credentials ensure that Dr. Kaufman possess the training and experience to achieve the best possible outcome for your skin cancer treatment.
Because skin cancer occurs in so many forms, degrees and locations, the fellowship program is designed to be thorough, stringent and all-inclusive. During his ACMS fellowship, Dr. Kaufman gained an uncommon level of exposure to a wide variety of situations and challenges, including rare tumor pathologies, difficult tumor locations and complex wound reconstruction. This intensive training provided him with the experience necessary to perform Mohs surgery and subsequent reconstruction for many different types of cases.
In order to complete the ACMS fellowship, Dr. Kaufman met the following requirements:
- Participated in a minimum of 500 Mohs surgery cases
- Learned to accurately interpret slides of tissue samples removed during Mohs surgery
- Performed a vast array of reconstructions, including the most complex, multi-step repairs
Dr. Kaufman completed his fellowship in Mohs micrographic surgery and dermatologic surgery at University of California San Francisco under the direction of Dr. Roy Grekin and Dr. Richard Glogau. Dr. Kaufman has been a fellow of the American College of Mohs Surgery since 1998 and had been a member of the ACMS Board of Directors. Dr. Kaufman is one of only a handful of doctors who is ACMS-fellowship-trained in Mohs surgery and practice in Ventura County.
The Mohs Procedure
The Mohs procedure is performed under local anesthesia. A very narrow piece of tissue is taken from the periphery of the visible skin cancer. The specimen is carefully removed, mapped and processed so that 100% of the surgical margins are evaluated for residual tumor. If any cancer is noted under the microscope, another thin margin is removed from the involved area and processed again. This is repeated stage by stage until the roots of the skin cancer are traced out completely. Once cleared of tumor, the surgical defect is reconstructed using side-to-side repairs, flaps, grafts or allowing the wound to heal by itself.
Mohs Surgery vs. Standard Surgical Excision
Cure rates for Mohs micrographic surgery depend upon the type of cancer being treated and whether the cancer has previously been treated, but for most instances cure rates for Mohs surgery tend to be higher than other forms of cancer treatment available. For basal cell carcinoma not previously treated the cure rate is approximately 98.5-99%. For recurrent basal cell carcinomas and primary squamous cell carcinomas the cure rates are approximately 95%. Mohs micrographic surgery is also useful for most other types of skin cancers, including lentigo maligna, lentigo maligna melanoma, microcystic adnexal carcinoma, and dermatofibrosarcoma protuberans.
Aside from superior cure rates another advantage of the procedure is the preservation of healthy tissue surrounding the skin cancer. This is accomplished by starting with narrower margins than are recommended for standard surgical excision of skin cancers. Mohs surgery can begin with narrower margins for most skin cancers because of the meticulous tracing out of the roots of the skin cancer that is part of the procedure. By preserving surrounding healthy tissue the resultant surgical defect should be as small as possible and still assure complete cancer removal. Small surgical defects mean that smaller or simpler repairs can be performed and therefore helps to minimize scarring and improve final cosmetic result.
The main disadvantage to patients compared to standard surgical excision is the time commitment involved. Patients need to plan to be at the office most of the day, since the number of stages needed to trace out the skin cancer varies case by case. Most will leave by early afternoon, but the small time commitment is considered by most to be a minor sacrifice in exchange for potentially higher cure rates and smaller surgical wounds for repair.