My daughter has been diagnosed with DFSP. We've been advised that MOHS surgery may not be appropriate for someone so young, and wide excision may be the best route to follow. The affected area is on her upper torso, and about 2cm in diameter. We're really not sure what to do for the best. Any advice greatly received.
Is MOHS Surgery Appropriate for a 4 Year Old?
Doctor Answers (5)
Mohs Surgery is best for DFSP
I agree with everyone on this post that Mohs surgery is the best for DFSP, but not in a 4 yo only because of the stress and discomfort of being awake for the procedure. DFSPs are rarely cleared in one stage using Mohs and thus the length of the probable procedure may be too difficult for the child. If you are looking for institutions that may be able to accomodate, then please send me an inquiry and I can help recommend some places that may be amenable to working with you to do Mohs in an anesthesia unit.
Mohs surgery for a 4 year old
While Mohs is the method with the highest cure rates it is a much too lengthy procedure for a 4 year old to tolerate without general anesthesia. I would recommend finding a Mohs surgeon and a Plastic/Reconstructive surgeon who could work together in the operating room to ensure the entire tumor is removed. I would suggest looking into medical centers in your surrounding area who have multi-disciplinary groups that work together for the best patient outcomes.
MOHs surgery for DFSP
There is nothing about Mohs surgery that mandates that it be done under local anesthesia. Mohs works well for DFSP tumors which have a high local recurrence rate uness they are excised completely. I would advise you to seek care at a medical center in which a Mohs surgeon is on staff - try the dermatology division of an academic medical center. Your child's Mohs procedure and reconstruction could be coordinated under the same anesthetic.
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Mohs Surgery for a Four Year Old
As pointed out by the other physician, Mohs surgery is basically a technique where essentially 100% of the surgical margins are evaluated under the microscope. As a result, the highest cure rates can be obtained. Mohs is excellent for DFSP; however, most Mohs surgeries are performed under local anesthesia and local anesthesia would not be appropriate for a 4 year-old. Your best bet would be to check with Mohs surgeons at academic centers (i.e. university hospitals with Mohs programs) so that you could have both Mohs surgery and the required pediatric anesthesia specialists. You could also try contacting the American College of Mohs Surgery for possible treatment centers.
Mohs Surgery for a 4 Year Old
Mohs surgery is essentially a tumor mapping technique that allows for the most accurate examination of margins, typically with lower recurrence rates than frozen section techniques. However, the majority of Mohs Surgeons perform surgery under local anesthesia, which is not advisable for a 4 year old. Therefore, the tumor mapping technique is excellent, but research into how this can be performed under anesthesia is required.