Saving Your Face
A diagnosis of cancer, especially on the nose and eyelids where 90 percent of squamous and basal cell carcinomas appear due to sun damage can be so shocking that many individuals fail to research the treatment options. Removing the cancer becomes urgent, with cosmetic concerns often taking a secondary place until the initial surgery is completed.
An all-in-one technique called Mohs surgery allows individuals with squamous cell or basal cell carcinomas, and melanomas, to have malignant tissue removed and analyzed, and reconstruction completed, in one day. According to John Vine, MD, assistant professor of medicine at UMDNJ-Robert Wood Johnson Medical School, Mohs is a step-by-step approach that preserves as much healthy tissue as possible without leaving any cancer behind. It's particularly useful when the tumor is on the face, the cancer has recurred and there's scar tissue from a previous surgery, the tumor is large, or its borders are ill-defined.
"It's frequently used when other procedures have failed," says Vine, who completed a one year fellowship in Mohs and other specialized surgical techniques, following a dermatology residency.
Vine explains that Mohs does not rely on the physician's eye to determine the extent of the cancer. The surgeon serves as a pathologist and bases the progressive surgical steps on what he discerns under the microscope.
First the obvious tumor is removed. The surgeon then cuts a thin layer of additional surrounding tissue and creates a "map" or drawing of the removed tissue to use as a guide in locating any remaining tumor cells. The removed tissue is then microscopically examined to check for evidence of remaining cancer cells.
If any of the sections contain cancer cells, the surgeon returns to the specific area of the tumor site as indicated by the map, and removes another layer of tissue only from the area in each section with cancer cells.
The removed tissue is again microscopically examined for additional cancer cells. This step-by-step procedure is repeated until there is no evidence of skin cancer.
"You could potentially take more tissue than is necessary if you did not follow this very precise method," Vine explains.
While elderly people make up the majority of Mohs patients, more middle aged people and even some in their late 20s and 30s have basal and squamous cell carcinomas on the face due to sun damage.
The procedure is done under local anesthesia. Any grafting of skin or tissue for wound reconstruction is done by the same surgeon on the same day.
What will your "best" face look like? "The cosmetic results are good," says Vine. "Human skin has an extraordinary ability to rejuvenate after surgery."
Winter 1998 Table of Contents