Think Mohs if confronted with difficult carcinomas

January 1, 2005

Philadelphia - To plastic surgeon Kenneth Olshansky, M.D., it's as clear a choice as washing hands prior to surgery. Given a nearly 95 percent cure rate, Mohs micro-graphic surgery is the method of choice for treating certain lesions.

Yes, the procedure is more complicated and time-consuming. This increases the cost. And if the physician of record isn't trained in Mohs surgery, a referral should be considered. Obviously, some calculations have to be made about which lesions merit the procedure and which don't.

"Most basal cell carcinomas can be successfully treated with the standard exam where the pathologist takes random sagittal sections through the specimen. For smaller, primary and nodular basal cell carcinomas, this technique is excellent," according to Dr. Olshansky.

In these cases, Dr. Olshansky insists, "We owe Mohs to the patient."

Losing half a face Mohs micrographic surgery is a meticulous process of marking, mapping and examining sections of a crater, once a tumor and the suspect tissue surrounding it has been removed.The goal is to examine 100 percent of the margins and base to reduce the rate of recurrence.

Mohs misconceptions Dr. Olshansky thinks Mohs microsurgery may have run into early skepticism after its introduction in the 1930s by Frederic E. Mohs, M.D., because doctors feared that cutting through tumors would spread cancer cells. They may also have been reluctant to prepare and apply a special zinc chloride paste prescribed by Dr. Mohs as a fixative.

Today, surgeons know basal cell carcinoma doesn't spread that way, and the paste has gone by the wayside, but Mohs remains underutilized - probably due to lack of emphasis in residency programs, says Dr. Olshansky. Out of roughly 25 plastic surgeons and 25 dermatologists in the Richmond area, Dr. Olshansky estimates that only two perform Mohs.