Top 10 Skin Cancer Tumors Treated by Mohs Surgery

Mohs micrographic surgery is an extremely versatile technique for removing and treating different kinds of skin cancers. Here are the top 10 tumors that can be treated with Mohs Surgery:

  1. Basal Cell Carcinoma (BCC) – The most frequently occurring form of skin cancer, BCC is an irregular spot or growth that can appear as an open sore, pink growth, shiny bump, red patch, or scar-like lesion on the skin. BCC arises in the skin’s basal cells, the bottom layer of the skin’s epidermis. This tumor never heals and if not treated quickly, can be quite disfiguring if allowed to grow.
  2. Dermatofibrosarcoma Protuberans (DFSP)– DFSP is a rare type of skin cancer that forms in the deep layers of the skin. It may start growing as a flat or raised patch that feels rubbery or hard and will look like a scar or wrinkly patch of skin that is discolored. It is most commonly found on the torso, but can also develop around the head and  neck, and on the arms and legs.  It has a tendency to reoccur about 15-50% of the time when treated with standard surgery, but with Mohs surgery this recurrence rate is reduced to less than 2%.
  3. Atypical fibroxanthoma (AFX) – AFX typically presents as a rapidly growing red bump or sore that arises in chronically sun-damaged skin (face, neck, scalp) or skin previously treated with radiation. It is more common in older individuals. This tumor can recur and spread to the lymph node is not completely treated and removed. Some consider AFX to be a superficial form of Malignant Fibrous Histiocytoma, a sarcoma cancer that can arise on the head and neck that is also amenable to treatment with Mohs surgery.
  4. Invasive Squamous Cell Carcinoma (SCC) SCC is the second most common form of skin cancer and can look like an open sore, elevated growth, scaly red patch, or wart that may crust or bleed. SCC arises from the squamous cells in the skin. These make up most of the upper layers of the skin’s epidermis.  SCC can be disfiguring creating open sores and invading local structures in the skin. SCC can even be deadly if neglected and allowed time to grow. SCC has a number of variants and subtypes. Mohs surgery is often considered the treatment of choice for many of these skin cancer variants as well.
    • Squamous Cell Carcinoma in Situ (also referred to as Bowen’s disease and Erythroplasia of Queyrat – depending on the histology and area of body involvement) is considered a superficial form of SCC, where the malignant cancer cells can be seen within the entire thickness of the epidermis (the very top layer of the skin) but don’t invade deeper. These lesions can spread laterally and ultimately may become invasive and spread if left untreated.
    • Verrucous Carcinoma is considered a low grade variant of SCC. It most commonly develops in the mouth of individuals who chew tobacco or betel nuts. It can however also arise on the head and neck, the genital areas and others.
  5. Microcystic adnexal carcinoma (MAC) – This rare tumor typically arises on the center of the face, as well as other areas of the head and neck. It is thought to be a malignant growth that develops from the sweat glands. Because the edges of this cancer are so difficult to identify clinically, Mohs surgery is the treatment of choice, with its ability to trace the tumors roots with a microscope and ensure the greatest chance of cure, even if the tumor wraps around nerves in the skin (which it can do).
  6. Merkel Cell Carcinoma – This rare but extremely aggressive form of skin cancer that usually arises in sun exposed areas and can metastasize quickly to the lymph nodes and spread to other areas of the body if not treated early. This tumor is considered to be a neuroendocrine tumor and recent research has found a virus (called Merkel Cell polyomavirus) to be the cause of this cancer in about 80% of cases. Still, Mohs surgery remains the one of the most effective therapy for treating these tumors in their early stages.
  7. Extramammary Paget’s Disease (EMPD) – this rare skin cancer typically arises in area with high concentrations of apocrine glands, particularly the genital area. It grows slowly, remaining confined to the skin for years.  Recurrence can be significantly reduced by using Mohs surgery to remove these growths and ensure the margins are clear. A significant portion of individuals with EMPD have an underlying internal cancer, in addition to EMPD.
  8. Angiosarcoma  – Angiosarcoma can resemble melanoma or another type of skin cancer. It appears as a red to blue or purplish bump or patch most often on the scalp or face. These cancers can have extensive roots in the skin making them very difficult to treat.
  9. Melanoma – Melanoma is considered one of the most dangerous forms of skin cancer. It develops when DNA damage occurs in the melanocytes, the pigment producing cells in our skin. This damage leads to a malignant growth of these cells that can spread throughout the body. Melanoma appears as a dark, irregular spot or mole on the skin. Some of the different subtypes of melanoma are effectively treated with Mohs surgery:
    • Lentigo Maligna- This dark discolored patch on the skin consists of malignant skin cells and usually develops in chronically sun exposed areas such as the face. Lentigo Maligna usually progresses very slowly and can remain on the skin for some time before becoming invasive.
    • Melanoma in Situ (MIS) – Considered the earliest stage of Melanoma (Stage 0), MIS sits in the very top layer of the skin and has not yet invaded or grown down to any of the deeper layers. It has not yet invaded any surrounding tissue nor spread to other areas in the body.
  10. With its unparalleled precision and versatility, many more than 10 types of skin cancer can be treated with Mohs surgery. Just some more of these include:
    • Malignant Trichoepithelioma
    • Adenocystic carcinoma
    • Sebaceous gland carcinoma
    • Leiomyosarcoma
    • Hemangiosarcoma

And others…

Dr. Adam Mamelak is a fellowship-trained Mohs micrographic surgeon that uses the technique to treat a variety of skin cancers.  If you would like more information, or if you would like to schedule a consultation with Dr. Mamelak, please contact Sanova Dermatology today.

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