The University of Arkansas for Medical Sciences (UAMS) is one of the few medical facilities in Arkansas that offers Mohs micrographic surgery – a specialized and highly effective treatment, with a cure rate of up to 99 percent at five years, for certain types of skin cancer. Daniel A. Davis, M.D., a new dermatologist and skin cancer surgeon at UAMS, has extensive training and experience in Mohs surgery and is certified in the procedure.

“Mohs micrographic surgery is the most precise method for removing all of the cancerous tissue while leaving the healthy tissue unharmed,” said Davis, an assistant professor of dermatology, pathology and otolaryngology/head and neck surgery in the UAMS College of Medicine. “Because Mohs surgery relies on the accuracy of a microscope, we’re able not only to identify and remove the cancer on the surface of the skin, but also to trace and remove the deep ‘roots’ of the cancer. In addition, this type of surgery lessens the potential for scarring and minimizes the chance of cancer regrowth.”

Skin cancer accounts for almost 50 percent of all new cancer cases. This year, more than 1 million people will be diagnosed with skin cancer and about 9,800 will die from the disease. The three most common types of skin cancer are melanoma, basal cell carcinoma and squamous cell carcinoma. Mohs micrographic surgery is sometimes used to treat melanoma, but it is primarily a treatment for basal cell and squamous cell carcinomas.

Melanoma, the deadliest form of skin cancer, originates in the pigment-producing cells of the skin and can readily spread to distant parts of the body where it continues to grow and destroy tissue. It appears as a pre-existing mole that changes or as a new mole on previously unaffected or clear skin.

Basal cell carcinoma develops most frequently in skin that is chronically exposed to the sun; these areas include the face, scalp, ears, neck, shoulders, hands and back. Although it rarely happens, this type of skin cancer is capable of spreading to other parts of the body if the tumor invades the lymph or blood vessels. Basal cell carcinoma appears as a pearly or shiny bump on the skin.

Squamous cell carcinoma develops in the outer layers of the skin and can spread to other areas if not treated in the early stages. This disease can develop in both light- and dark-skinned people. It can occur at the sites of scarring, skin disease, chemical and thermal burns, and chronic skin ulcers and in sinus tracts. Red, scaly spots on the skin might be an early sign of squamous cell carcinoma.

Overall, Mohs micrographic surgery is indicated when the cancer has recurred following previous treatment or poses a high risk for recurrence; the cancer is in an area – such as the eyelids, nose, ears, lips, hands, feet and genitals – where it is important to preserve healthy tissue for maximum functional and cosmetic purposes; the cancer is large; the edges of the cancer cannot be clearly defined; the cancer grows rapidly or uncontrollably; and the cancerous area contains scar tissue.

“Mohs surgery is an outpatient procedure that’s performed under local anesthesia,” explained Davis, a member of UAMS’ Arkansas Cancer Research Center where he sees patients. “The process alternates between surgery and microscopic examination. We start by surgically removing all of the visible skin cancer. Then, to determine how deep the cancer ‘roots’ go, we remove an additional thin layer of tissue from the tumor area. After using this tissue specimen to create a ‘map’ of the surgical site, we thoroughly examine the specimen under the microscope to check for evidence of remaining cancer cells. If cancer cells are detected in a specific section of the tumor site, we use our ‘map’ to return to that particular section and remove another thin layer of tissue for microscopic testing. This process continues layer by layer until the cancer is completely gone.”

There are several options for managing the surgical site after all the skin cancer has been removed. Some wounds, especially smaller ones, may be allowed to heal on their own. Other wounds may need to be closed with stitches, a skin flap or a skin graft. A skin flap provides coverage by utilizing the skin that is adjacent to the wound, while a skin graft covers the surgical site by using skin from another area of the body.

Postoperatively, the patient may experience some mild discomfort and some bruising and swelling, especially if the surgery was around the eye area. Although rare, possible complications of Mohs micrographic surgery include weakness in a portion of the face and tenderness, numbness, intermittent itching or shooting pain in and around the surgical area.

To obtain more information about skin cancer, Mohs micrographic surgery and other treatments for skin cancer or to make an appointment with Davis at UAMS, call (501) 686-8275.