COLORADO SPRINGS — Colorado Springs resident, Vic McMillan who’s 79 years old - tells me in jest that now he uses sun screen like after shave - and was willing to share with me his ongoing battle with skin cancer, including some hard to see images of the nearly 50 surgeries he’s endured.
His dermatologist, Dr. Brett Matheson, MD, FACMS with the Skin Cancer and Dermatology Center of Colorado Springs has done nearly all of those Mohs surgeries. The Mohs surgical technique was first developed by Dr. Frederic E. Mohs, in the late 1930’s and that’s where it gets its name. The Mohs surgical technique is most often used to treat basal cell or squamous cell carcinoma, which are not typically life threatening cancers like melanoma, but Dr. Matheson says it’s critical that you don’t ignore the symptoms.
So how does a surgeon ensure that all the cancer is removed, while not removing healthy skin from the face and neck and causing a large amount of scarring?
Dr. Matheson says, “Mohs surgery has become the gold standard for skin cancer treatment especially for cancers that develop on the face. The process of Mohs surgery involves excising a cancer in a series of layers or stages, to minimize the scar - or in other words spare normal tissue. So we cut very thin margins and check those carefully under the microscope to ensure that all the cancer is clear. Mohs surgery is done in the office under local anesthetic so it’s very safe but it’s very precise. Because it’s so precise It’s a little time intensive. The cancer is excised layer by layer. Each layer is checked under the microscope by the surgeon who acts as the pathologist to ensure that cancer is clear from the margins. Because 100% of the margin is carefully checked while the patient is here in the office - a high cure rate is obtained.
According to the Skin Cancer Foundation, Mohs surgery has a skin cancer cure rate of 99%.
What’s it like to undergo Mohs surgery? Vic certainly has a lot of experience. He says the only painful part of the procedure is the lidocaine shots used to numb the area. “Even with my procedures that have produced large incisions that were stitched up I would take a couple of Tylenol for a couple of days as it heals up.”
As for extra time spent in the office because each layer of the lesion is prepared as a slide to be viewed under the microscope by Dr. Matheson, Vic says if all the cancer hasn’t been removed “He (Dr. Matheson) goes back in and he’ll cut some more out of it and he’ll check the edges and when the edges are clear you’re done. He sews it up. If it’s not clear he comes back with his scalpel and cuts some more until it is. The most I’ve had is five, and that’s only been once. He seems to like the number three with me.”
The Mohs technique of cutting conservatively in layers and checking the margins ensures the least amount of healthy skin tissue is removed. Add in the surgeon’s expertise of closing the wound and scars on the face and neck, even large scars become nearly invisible. Dr. Matheson says, “Part of my surgical training was not just the removal of the skin cancer but the reconstructive techniques afterwards to sort things out so that the scar disappears along normal tension lines so the scar becomes almost invisible whenever possible. When necessary I perform flaps or graphs or complex reconstruction but most of the time wounds can be closed in a straight thin little line or some can even be allowed to heal on their own. The skin is a beautiful organ and it heals beautifully. Initially a patient might be rather surprised at the size of the wound necessary to clear a cancer but with proper surgical technique and the closure of that wound usually things heal really well.”
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