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Old 02-12-2013, 01:02 AM
gdpawel gdpawel is offline
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Default Mohs Surgery OK in Seniors Aged 90 Years or Older

(HealthDay News) -- Mohs micrographic surgery (MMS) is safe in seniors aged 90 years or older, according to a study published in the February issue of the Journal of the American Academy of Dermatology.

Amy Delaney, M.D., from the Geisinger Medical Center in Danville, Pa., and colleagues assessed patient demographic and clinical characteristics in 214 patients aged 90 years and older who underwent MMS from July 1997 to May 2006. The Charlson index was used to identify comorbid medical conditions.

The researchers found that there were no deaths within one month after surgery and that all patients tolerated the procedure well. Median survival was 36.9 months following surgery. Survival was not affected by tumor characteristics, defect size, number of surgical stages, or closure type. Comorbidities did not significantly affect survival.

"This growing section of the population may safely undergo MMS and should not be relegated to other less effective treatments through fear of affecting their survival," Delaney and colleagues conclude.

Life expectancy after Mohs micrographic surgery in patients aged 90 years and older

Amy Delaney, MD, Ikue Shimizu, MD, Leonard H. Goldberg, MD, Deborah F. MacFarlane, MD, MPH

Background:

The population of people aged 90 years and older is expected to more than triple by 2050. The incidence of skin cancers is increasing.

Objective:

We sought to determine whether treatment of patients aged 90 years and older with skin cancer by Mohs micrographic surgery (MMS) changed their survival.

Methods:

A group of 214 patients aged 90 years and older who underwent MMS from July 1997 to May 2006 was identified. Patient gender, age, tumor type, size, site, defect size, number of MMS stages, and surgical repair were recorded. Comorbid medical conditions were assessed using the Charlson index. Actual survival was compared with expected length of survival using life tables. Data were analyzed by the Kaplan-Meier method with log rank significance tests.

Results:

Average patient age was 92.3 years. All patients tolerated the procedures well with no deaths within 1 month after surgery. Median survival after surgery was 36.9 months. Tumor characteristics, defect size, number of surgical stages, and closure type did not affect survival. There was no significant difference in survival based on comorbidities according to Charlson scores. Instantaneous mortality hazard was highest 2 to 3 years after surgery.

Limitations:

Specific causes of death were not accessible.

Conclusion:

This growing section of the population may safely undergo MMS.

Journal of the American Academy of Dermatology Vol. 68, Issue 2, Pages 296-300

[url]http://www.mohscollege.org/about/
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Old 02-12-2013, 01:07 AM
gdpawel gdpawel is offline
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Default Mohs Micrographic Surgery: An Overview

New treatments for skin cancer are appearing and evolving rapidly in recent years. However, one surgical technique has more than stood the test of time. Developed by Dr. Frederick Mohs in the 1930s, Mohs micrographic surgery has, with a few refinements, come to be embraced over the past decade by an increasing number of surgeons for an ever-widening variety of skin cancers.

Today, Mohs surgery has come to be accepted as the single most effective technique for removing Basal Cell Carcinomas and Squamous Cell Carcinomas (BCCs and SCCs), the two most common skin cancers. It accomplishes the nifty trick of sparing the greatest amount of healthy tissue while also most completely expunging cancer cells; cure rates for BCC and SCC are an unparalleled 98 percent or higher with Mohs, significantly better than the rates for standard excision or any other accepted method.

The reason for the technique's success is its simple elegance. Mohs differs from other techniques in that microscopic examination of all excised tissues occurs during rather than after the surgery, thereby eliminating the need to "estimate" how far out or deep the roots of the skin cancer go. This allows the Mohs surgeon to remove all of the cancer cells while sparing as much normal tissue as possible. The procedure entails removing one thin layer of tissue at a time; as each layer is removed, its margins are studied under a microscope for the presence of cancer cells. If the margins are cancer-free, the surgery is ended. If not, more tissue is removed from the margin where the cancer cells were found, and the procedure is repeated until all the margins of the final tissue sample examined are clear of cancer. In this way, Mohs surgery eliminates the guesswork in skin cancer removal, producing the best therapeutic and cosmetic results.

In the past, Mohs was rarely chosen for Melanoma surgery for fear that some microscopic melanoma cells might be missed and end up spreading around the body (metastasizing). However, efforts to improve the Mohs surgeon's ability to identify melanoma cells have led to special stains that highlight these cells, making them much easier to see under the microscope. Thus, more Mohs surgeons are now using this procedure with certain melanomas. With the rates for melanoma and other skin cancers continuing to skyrocket, Mohs will play an ever more important role in the coming decades.

[url]http://emedicine.medscape.com/article/1125510-overview
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Old 03-03-2013, 06:20 PM
gdpawel gdpawel is offline
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Default What is all involved in Mohs’ Micrographic Surgery?

Mohs micrographic surgery has the highest cure rate for basal cell carcinoma and squamous cell carcinoma. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of removed cancerous tissue to give assurance that the “roots” of the carcinoma has been eliminated. Mohs surgery is reserved for skin cancers that grow back from previously treated cancers, cancers that are at high risk of reoccurrence, cancers that are located in cosmetic areas where preservation of skin is important (such as the face), and for large skin cancers. This procedure tends to minimize scaring over other therapies with the goal of achieving an optimal cosmetic result with high cure rates.

Procedure:

Mohs surgery is performed by anesthetizing the skin with a local anesthetic followed by removing a thin layer of skin involved with the cancer. This process generally takes about 15 minutes. A cauterizing machine which generates heat will be used to stop the bleeding. The surgical assistant will dress the wound and ask that you proceed to the waiting room while the tissue is being prepared for microscopic examination which takes approximately 1- 1.5 hours. If the examination of the tissue reveals that your tissue still contains cancer cells, the procedure will be repeated. Several surgical excisions and microscopic examinations may be performed in one day. The average number of surgical sessions for most skin cancers is two or three, so most patients are finished by mid-afternoon. When the skin cancer has been determined to be completely removed, recommendations on the best closure choice for the wound will be discussed.

Side effects:

Some patients may feel some discomfort following the surgery therefore taking acetaminophen every four hours is recommended. Avoid aspirin-containing medications or NSAID. Most wounds will ooze a small amount of blood in the first few days. Rarely does significant bleeding occur following surgery however if it should happen, apply firm, continuous pressure for 20 minutes. Swelling is common following surgery, especially when surgery is performed around the eyes. Infrequently, wounds will become infected and an oral antibiotic will be necessary.

Source: Dermatology, Inc
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Old 06-17-2013, 11:58 AM
gdpawel gdpawel is offline
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Default What is the role of the dermatologist in treating basal cell carcinoma?

Ritu Saini, M.D.
Board Certified Dermatologist
Specializing in Mohs Micrographic Surgery

The dermatologist is the primary specialist to treat basal cell carcinoma. Dermatologists are trained to treat basal cell carcinoma in a variety of ways - excising or surgically removing the tumor, scraping and burning it, using topical chemotherapeutic medication and photodynamic therapy in the case of a superficial basal cell carcinoma, and with Mohs micrographic surgery.

If basal cell carcinoma is suspected, a biopsy of the lesion should be taken. This involves anesthetizing the lesion with a local anesthetic like lidocaine and shaving the lesion off with a blade. The specimen is then sent to a lab to be evaluated by a dermatopathologist. If it is determined to be basal cell carcinoma, a treatment plan should be designed based on the nature of the basal cell carcinoma and the anatomical site.

A person is at high risk for basal cell carcinoma if they have had excessive sun exposure throughout their lives. A positive family history also plays a role in determining whether or not someone is at risk of developing basal cell carcinoma. Previous radiation or immunosuppression, as well as treatment with ultra violet light also increases ones chance of developing the cancer, just as does tanning booth use.

The best ways to prevent basal cell carcinoma are strict sun avoidance and protection. Wearing a sunscreen with spf 30 + everyday and avoiding the sun at peak hours between 11 am and 4 pm is recommended. Complete avoidance of tanning salons is also suggested to prevent against developing basal cell carcinoma.
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