Can Mohs surgery be used to treat melanoma skin cancer with MART-1 staining?
Melanoma skin cancer impacts the lives of roughly 120,000 Americans each year. If you have been diagnosed with melanoma, it is important to seek effective and timely treatment.
Traditionally, a physician will recommend a wide local excision for treatment of a melanoma skin cancer. Basically, this means the melanoma is cut out of the skin with a generous margin of surrounding skin. This is performed to ensure the entire skin cancer is removed, and not a single cancerous cell is left behind. Leaving a melanoma in place, or delaying treatment of melanoma is not recommended and can have dire consequences on one’s health.
Recently however, more and more melanoma are being treated with Mohs micrographic surgery. As you may or may not know, Mohs surgery burst onto the cancer treatment scene decades ago. Since that time, health care professionals have been discovering an increasing amount of ways to incorporate it into patient care. The treatment of melanoma is just one of them.
Dr. Adam Mamelak, dermatologist and Mohs surgeon at Sanova Dermatology uses Mohs surgery to treat different types of melanoma, including melanoma in situ and lentigo maligna. “When you look at the conflicting data published on melanoma margins – how much surrounding skin you need to take to guarantee the entire cancer is removed – Mohs just makes sense!” says Dr. Mamelak.
Dr. Mamelak authored the book chapter on the use of Mohs surgery for the treatment of melanoma in “Mohs Surgery and Histopathology: Beyond the Fundamentals” (Cambridge University Press, New York, NY, 2009), the reference textbook used by fellow physicians and surgeons when training and perfecting the Mohs technique.
Unlike other surgical forms of cancer removal, the Mohs’ method has several distinct advantages that make it ideal for treating specific types melanoma. For starters, it has a very high success rate. In addition, it can effectively address the cancer’s microscopic spread in the least invasive, precise way possible. A much smaller margin of health skin tissue is removed with Mohs surgery, allowing for conservation of non-cancerous, healthy skin. As a result, the patient may experience less cosmetic, safety and recovery time related concerns. Overall, less scarring is the result.
While Mohs for melanoma has had its critics, a 2005 study of over 500 patients who had their melanomas treated with Mohs surgery, showed similar outcomes when compared to melanoma patients who had wide local excision. Specifically, similar recurrence, metastases, and survival rates were observed in the two groups.
The way it works is simple. During the surgery, Dr. Mamelak uses a microscope to slowly examine each layer of the patient’s affected area. In the process, Dr. Mamelak removes the diseased layers of skin until only healthy, cancer-free tissue remains. Although the microscope is an extremely important tool, melanoma cells can sometimes be hard to visualize, even under the best conditions. That’s where the MART-1 stain comes in – an integral part of the Mohs for Melanoma process that ensures all of the cancerous cells are removed.
So what is a MART-1 stain? MART-1, also sometimes referred to as Melan-A, is a gene encoded antigen. Gene encoded antigens are frequently found in diseased tissue. “Basically, it is a protein produced specifically by melanocytes and melanoma cancer cells,” explains Dr. Mamelak. “Using this protein as a target, we can make a highly specific stain that lights up melanoma cancer cells so they can be easily seen and detected under the microscope.”
The MART-1 stain is applied to a potentially diseased tissue section, and essentially seeks out and discolors the microscopic cancer cells. That, in turn, makes it easy for a Mohs surgeon to see and subsequently remove all of the diseased tissue.
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