Skin-conserving surgeries for skin cancer

December 01, 2012
Dr. Christopher Zachary

Most types of skin cancer, such as basal and squamous cell cancers, are highly curable when treated early and appropriately. But the true size and extent of many skin cancers may be more than skin deep.

"It is important to recognize that what is visible on the skin’s surface may be just the tip of the iceberg," says dermatologic surgeon Dr. Christopher Zachary, chair of the UCI Health School of Medicine's Department of Dermatology. "Only with a microscopic exam is it possible to determine the extent of the tumor," Zachary says.

"Mohs micrographic surgery enables us to trace out the roots of the cancer, minimizing damage to the surrounding normal skin," explains Zachary, who is certified by the American College of Mohs Surgery. One of only several fellowship-trained Mohs skin surgeons in Orange County, he performs the procedure with a highly skilled team of medical professionals at the UCI Health Dermatology Center in Irvine.

With Mohs micrographic surgery, the patient can be assured of the complete removal of all cancer cells while sparing surrounding tissue, says Zachary. Performed on an outpatient basis without the need for general anesthesia, Mohs surgery has the highest cure rate available, at close to 99 percent for new skin cancers and 95 percent for recurrent cancers.

The Mohs technique allows the surgeon to remove the entire skin cancer without taking more healthy skin than is absolutely necessary. For this reason, Mohs is especially appropriate for treating skin cancers that:

  • Are in areas where preserving cosmetic appearance and function are important, such as the face, head and neck
  • Have grown back or are likely to recur
  • Have ill-defined edges or are in an area of scar tissue
  • Are large in size and/or are growing rapidly.

Mohs is a highly specialized surgical technique first developed in the 1930s by Dr. Frederic E. Mohs, a professor of surgery at the University of Wisconsin. The basic principle is to examine 100 percent of the margins of all excised tissue before repairing the area.

With Mohs, the dermatologic surgeon carefully maps and color-codes the cancerous tissue before excising it. The tissue is then examined microscopically at the time of surgery. If the margins show evidence of more cancerous cells, more tissue is carefully excised and tested. The process is repeated until all margins are determined to be clear of cancerous cells.

Each stage can take about an hour, with most of that time spent on freezing and preparing tissue slides, examining the tumor tissue and interpreting the results.

Unlike Mohs, standard surgical excision technique requires that a specimen be sent to a pathologist for processing and review, which can take up to a week for results. In addition, standard excision only allows for examination of about 1 percent of the tumor’s margins. Because so small a percentage is tested, a residual tumor may be overlooked. If more cancer cells are found in the subsequent pathology examination, a second surgery would be required.

Our Mohs teams at UCI Health consists of a surgeon, a nurse, a histotechnician, a board-certified dermatology fellow and dermatology residents. Our team members, who have the most extensive training and expertise in the Orange County, are dedicated to providing the highest quality care to patients diagnosed with skin cancer.

Learn more about the Mohs procedure ›

Learn more about Dr. Zachary ›

For more information or to make an appointment, call 949-824-0606.