User:Heacock.e/sandbox

= Moh's Micrographic Surgery =

Frederic Mohs
Frederic E. Mohs accomplished many things in his life but his most successful by far and most well-known accomplishment was the development of Mohs Surgery, a method of skin cancer removal. Dr. Mohs grew up in an upper middle-class family, although neither of his parents had any background in the medical field. In his childhood, the family relocated to Madison, WI in order for Frederic’s brother, Carl, to further his education. As Frederic was growing up and continuing school, he found that he loved radio and communication. Mohs loved to gain signals from faraway places and further his knowledge of this new form of communication. This passion of his continued through high school and led to him pursuing an engineering degree at the University of Wisconsin–Madison. To fund his education, Mohs began working in a lab at the University and got paid for feeding the animals there. It was through this employment opportunity, Mohs’ realized he had a passion for medicine and learning more about the physical body. He made discoveries with mice using Zinc chloride. During his time as an undergraduate student he was even able to create a technique using in-situ tissue. Dr. Mohs then went on to medical school and completed his residency in Oregon.

Mohs surgery is used very widely today, and the technique is much more advanced than it originally was when Mohs first created it. The first technique started with acetic acid and then a paste made of Stibnite, sanguinaria root, and zinc chloride, was used. After the application of the paste, the patient would return to the makeshift operating room each day and another layer of the cancerous lesion would be removed. This process was not nearly as painless as it is today, and it took a much longer time, but this was the baseline technique that developed into our modern day Mohs surgery. While Dr. Mohs gained support for his new technique, he also gained many opposers and many people even wanted his medical license to be taken away.

Benefits of Mohs Surgery When Treating Non-Melanoma Skin Cancer
Mohs surgery is not only effective in completely removing harmful skin cancers, but it is more appealing to patients who are concerned about unsightly scarring because it is done with such great detail and precision. Basal-cell carcinoma s and Squamous cell carcinoma s were the only skin cancers that were originally treated using this technique. As it developed further, Melanomas were also able to be treated by this method. Specifically, Melanoma in situ. The risk of a tumor recurring is also greatly lessened after Mohs excision. The popularity of Mohs surgery as a treatment method has grown among dermatologists for various reasons, one of those being the fact that only the smallest amount of tissue necessary to get the tumor out is removed. Basal cell skin cancers have the lowest recurrence rate out of all of the types skin cancers that can be treated by Mohs surgery.

While squamous cell skin cancer is more invasive than basal cell skin cancer, it can still be treated with Mohs surgery. Squamous cell carcinomas are typically caused by sun exposure which leads to skin damage, however, people who have had organ transplants are far more likely to squamous cell skin cancer. Ideally, a patient would only need one Mohs excision for a specific cancer, but with recurrent squamous cell carcinomas, Mohs excision can be performed if they end up recurring. Because squamous cell carcinomas can spread to the rest of the body if not treated properly, some Mohs surgeons will take out more tissue if the squamous cell cancer seems to be farther along in development so possible metastasis can be avoided. This method has been proven to be very successful, but it is important that it should not be used for lesions that do not absolutely warrant this treatment.

Mohs Technique
While the entirely of Mohs surgery is done in various phases, there is no protocol that is set in stone when it comes to determining when to cauterize and using the Curettage and cautery technique. It can be difficult for Mohs surgeons to determine the exact margins of a particular skin cancer, especially because patients to not want to end up losing more tissue than they need to.

Because mohs surgery is done in steps where the surgeon takes out some of the cancerous areas of skin and then takes time to look at the specimen under a microscope, it can sometimes take all day. However, with the use of curettage it is possible to lessen the number of sessions the surgeon has to end up doing. In turn this would benefit the patient by creating a less expensive bill and it would also save the time of both the surgeon and the patient. Although research has been done to determine whether or not this technique is actually effective when it comes to lessening the number of sessions the surgeon must do, any definitive answers have yet to be found.

While it’s the goal for skin cancers to never recur after being treated with Mohs surgery, it’s not uncommon for these cancerous leasion to recur in areas such as the face, lips, genitalia, hands, and feet. As a national average, Mohs excision is done on about 876,000 skin cancers per year. Because this surgery often ends up producting hefty medical bills, most of these procedures end up being covered through Medicare (United States). The use of this type of surgery has been increasing exponentially in the United States since the end of the 20ht century. Researchers are unsure as to whether this reasoning stems from an increase of the number of Non melanoma skin cancer s in the United States or if it’s because the number of practicing Mohs surgeons is increasing which would then make the treatment more of a viable option. Researchers did, however, determine that in areas with a higher concentration of practicing Mohs surgeons, the overall number of non-melanoma skin cancers that were treated was much higher.

Mohs Recovery Process
Having a skin cancer removed by a surgeon using the Mohs Technique is an outpatient procedure and does not require an overnight stay. The surgery is performed in a very localized area so the recovery time is not similar to that of a major surgery. Undergoing additional repair processes is optional to the patient and depends on the severity of the scar from the surgery. Patients can elect to see a plastic or other dermatological surgeon to aid in the recovery process, but this part of the post-care treatment is purely cosmetic.