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Mohs Surgery Is 'Gold Standard'

Conquest - Fall 2010

Deborah Mac Farlane, M.D., greets Charles LeMaistre, M.D., as he pays a visit to the Mohs and Dermasurgery Center. A former president of MD Anderson, LeMaistre is also a patient at the center, where he received treatment for basal cell carcinoma and returns regularly for check-ups. Photos: John Everett

Specialized treatment for skin cancers

By Lana Maciel

When Charles LeMaistre, M.D., was president of MD Anderson, he played a monumental role in building the institution’s reputation for complete cancer care. But it wasn’t until June 2009 when he would fully experience that level of care himself.

Diagnosed with basal cell carcinoma, LeMaistre chose to have the lesion removed at MD Anderson’s Mohs and Dermasurgery Unit, part of the Department of Dermatology, which he personally helped build and grow during his tenure as president from 1978 to 1996.

His experience at the Mohs Unit involved three doctors who specialize in different fields. Each played a critical part in his comprehensive care. Madeleine Duvic, M.D., deputy chairman of the Department of Dermatology, consulted LeMaistre regarding his screening and prevention; Deborah Mac Farlane, M.D., professor in the Department of Dermatology and a Mohs surgeon, performed the surgery to remove the lesion from the tip of his nose; and Roman Skoracki, M.D., professor in the Department of Plastic Surgery, performed the reconstructive surgery.

This multidisciplinary approach to diagnosis and treatment is what makes the Mohs Unit one of the most specialized clinics in skin cancer therapy. And according to LeMaistre, its highly skilled faculty provide efficient care with a dedication to the preservation of healthy skin from the beginning to the end of treatment.

The ‘gold standard’ of care

Since its establishment, the Mohs and Dermasurgery Unit has offered specialized treatment for skin cancers. The highly specialized service of Mohs micrographic surgery is ideal for many types of lesions and skin cancers, but it is most often used to treat primary or recurrent basal and squamous cell carcinomas that appear on the body where tissue conservation is especially important.

While a number of services and procedures are performed, Mohs surgery is the most common procedure done at the clinic, says Mac Farlane, director of the Mohs Unit.

“For non-melanoma skin cancers on the head or neck area, Mohs surgery is the golden standard,” Mac Farlane says. “The tumor is mapped and tracked stage by stage so that we maximize the amount of tumor removed and minimize the amount of normal tissue removed. With each stage, we test 100 percent of the margin until it is clear, so we can guarantee approximately 98 percent to 99 percent of the time (for previously untreated tumors) that the tumor won’t come back.”

In most cases, Mohs surgery is an outpatient procedure that uses a local anesthesia and is completed in one visit. Patients not only receive consultation and surgery at the clinic, but doctors and surgeons from other departments also may be brought in to assist in a patient’s pre- or post-surgery needs. Interdepartmental collaboration with the departments of Radiation Oncology, Diagnostic Imaging, Dermatology, Plastic Surgery, Head and Neck Surgery and Melanoma Medical Oncology helps complete the full circle of care that patients have come to expect at MD Anderson.

Collaboration benefits patients

Patient Stuart Luster undergoes preparation for his
fifth and final surgery in two days at the Mohs Unit.

Physicians who treat other types of cancers also recognize the expert treatment given at the Mohs Unit. They will often refer their patients to Mac Farlane and her experienced staff for further treatment, particularly if the patient is elderly and cannot undergo general anesthesia, or when the patient develops skin cancer as a second cancer.

“A lot of patients here at
MD Anderson are immunocompromised, so they are more prone to developing skin cancer,” Mac Farlane says. “In particular, organ transplant recipients, patients with leukemia or lymphoma, or those who have received radiation have an increased risk of developing skin cancer. In those cases, Mohs surgery is often the best choice for treatment.”

Maintaining an active collaboration with other departments is a goal the physicians at the Mohs and Dermasurgery Unit aim to achieve. Not only does it further advance skin cancer therapy, but it also provides patients with the kind of treatment plan that optimizes recovery and overall health. It’s a true reflection of the
MD Anderson mission LeMaistre helped put into practice 30 years ago.

“The Mohs and Dermasurgery Unit is an integral part of the MD Anderson care program,” LeMaistre says. “I think it’s one of the hidden gems of the institution. My entire experience at the clinic was a true example of the complete care that
MD Anderson is known for, from prevention and treatment to recovery.”

Getting to Know the Mohs and Dermasurgery Unit

The Mohs and Dermasurgery Unit at MD Anderson looks just like any other doctor’s office from the outside. But take a closer look and you see that there’s much more to this “hidden gem” than meets the eye.

The unit houses eight operating rooms with a relatively small staff that consists of three Mohs surgeons, one nurse manager, three registered nurses, three medical assistants, two histotechnicians, one medical photographer, three front desk assistants and one fellow in training. A number of residents and medical students are also constantly rotating through the clinic to gain hands-on experience in dermatologic surgery.

Mohs microscopic surgery was developed by Frederic E. Mohs, M.D., a surgeon who pioneered the cancer-removing technique in 1936.

They all stay busy. In the past year, the Mohs Unit has performed between 600 and 900 procedures each month, including biopsies, Mohs micrographic surgery, mole removal, laser surgery, scar revision, removal of atypical pigmented lesions and CO2 laser treatment of benign and malignant skin growths.

The Mohs faculty offer expertise in the treatment of a variety of dermatologic diseases and conditions. In addition to surgery, the Mohs Unit also treats skin cancer patients using various non-surgical modalities such as photodynamic therapy, cryotherapy, and topical and intralesional therapies.

© 2015 The University of Texas MD Anderson Cancer Center