Many thanks to dermatologist Sandy Martin MD for answering my original questions (Can a cancerous growth go away on its own). A bioopsy confirmed that I have Basis Cell Cancer. Is there a difference between Mohs surgery performed by a dermatologits and cancer removal of Basil Cell by a plastic surgeon? Both say they take a thin margin of skin and send itto the lab, then they take more skin if cancer still present but stop if there is a clear margin. Is one more effective statistically?
Is There a Difference Between Mohs Surgery Performed by a Dermatologist and Cancer Removal of Basil Cell by a Plastic Surgeon?
Doctor Answers (2)
A well done Mohs surgery should have a higher cure rate (98%) than surgery done with frozen section (90%) AND should result in more tissue preservation. You can still use a plastic surgeon for reconstruction following the Mohs surgery if you wish. Dr. Kaufman explains the process very well.
If the cancer is in an area with a lot of loose tissue (like the arm) excision with carefully examined margins can be fine as well. If the cancer is on the face or very large, go with Mohs. Good luck!
Difference Between Mohs Surgery and Frozen Section Removal
Mohs surgery requires that one person act as both surgeon and pathologist and that the tissue is mapped and processed so that virtually 100% of the periperal and deep surgical margins are viewed microscopically.
Frozen section removal by a plastic surgeon would suggest that the tissue is sent off and processed and read by another specialist, probably a pathologist. How the tissue is processed is also critical. Some laboratories will cut vertically through the tissue, a process called "breadloafing" in that it resembles slices in a loaf of bread. Some may perform a more meticulous evaluation of the surgical margins. So you need to check and see how the tissue would be processed.
Mohs surgery has a 98.5-99% cure rate for previously untreated basal cell carcinoma according to the scientific literature. I am unaware of similar studies that look at frozen section surgery (in part because of the differences in how the tissue is processed by various laboratories).
The American College of Mohs Surgery recommends that you see a Mohs surgeon that has completed a 1-2 year fellowship in Mohs surgery and is a member or fellow of that College. That assures that the doctor performing the Mohs surgery has spent additional training after residency learning the Mohs procedure, interpretation of the slides and performing the necessary reconstruction. Good luck.