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Dr. Michaels' Blog

Skin Cancer on My Face? I Want Moh’s, Or Do I?

You’ve just found out you have Basal Cell or Squamous Cell skin cancer on your face. You want it gone yesterday. You want no recurrence.  You want as small a scar as possible.  Right?  So, what do you do? Treatment options are confusing:  Surgery? Radiation and/or chemotherapy?  Surgery still has the best cure rates and the most predictable scar.  But what kind of surgery is the best for you? 

An option that has grown in popularity is Moh’s Micrographic surgery. Moh’s is always performed by a specially trained dermatologist who acts as his own pathologist.  Although it’s an effective technique, the dermatologist is the cancer surgeon, the pathologist and the reconstructive surgeon.  With only one doctor performing multiple complicated roles the process takes hours and results may not be as good as when different specialists work together.

Skin cancer surgery at a dedicated facility performed by a plastic surgeon with a pathologist, accomplishes the same goal–getting rid of your cancer–but it’s faster and you have a plastic surgeon closing the skin for the best scar.

Let me explain. Non-melanoma type skin cancer grows outward from a central core. The key to getting the smallest scar is to control the margins of resection.  This simply means removing the cancer with a cancer-free margin all around it. The thinner the margin, the smaller the scar, but the margin must be absolutely free of cancer cells.

 How do we know that the margin is completely clear?   By examining it microscopically.  Very thin sections of margin tissue are flash frozen, prepared on slides and examined under the microscope by a pathologist.  If the slide shows any cancer, the surgeon removes more tissue and sends it back to the pathologist. This exchange continues until the margin is entirely clear.

The problem with Moh’s surgery is limited personnel.  The surgeon/dermatologist can’t prepare and read slides while performing the surgery. He or she must run back and forth between the O.R. and the pathology lab.  When the margin is clear, the Moh’s surgeon either reconstructs the wound him/herself or sends the patient to a plastic surgeon.  Waiting to see a plastic surgeon can take anywhere from several hours to several days. Not a good amount of time to have an open wound, especially on the face. 

On the other hand, if the plastic surgeon has a pathologist standing by, you get the best of both worlds:  The margins can be microscopically examined during the surgery, and a cosmetically sensitive reconstruction can be done in the same operation.

At Berkshire Cosmetic and Reconstructive Surgery Center, we have an in-house pathology team.  Our board-certified plastic surgeons work with this highly trained pathology team to provide fast, safe, and cosmetically sensitive removal of your skin cancer. 

The surgery takes place in a comfortable ambulatory surgery setting, not in a hospital, and—best of all—you don’t have to travel to New York or Boston to get it. We can take care of your skin cancer right here.