409 - MOHS Surgery

| The Surgical Technologist | JANUARY 2018 16 in a more local problem, growing wider and deeper in the tissue. Squamous cell carcinoma is the second most common type of skin cancer with more than one million cases diag- nosed each year. It is also found on sun-exposed areas, but also can arise on mucous membranes and genitals. When found, it typically presents as a thick, rough scaly patch or as a crateriform bump. Unlike basal cell carcinoma, if it is left untreated, it can spread to other areas of the body. The deadliest form of skin cancer is melanoma. It arises from melanocytes that give skin its color. When melanoma is found early, it is highly treatable; however, it can spread to other areas if not caught at an early stage. It may appear as a new mole or in an existing mole, which usually appear as an irregular brown or black color. Melanoma also can be seen as a dark streak on the surface of a nail. H I S T O R Y O F M O H S Mohs micrographic surgery is a tissue-sparing procedure that allows for 100% margin analysis. It was named after the founder of the procedure, Frederic E Mohs, MD (1910- 2002). He first performed surgery for a squamous cell car- cinoma on the lower lip in 1936 using his technique that required patients to wait days until the tissue was processed to get results. In 1953, he performed his first fresh tissue excision on an eyelid, which yielded excellent results in a quicker time frame. He would then go on to use the fresh tissue excision on all eye lid procedures, branching out to other areas of the skin, which is how Mohs surgery was created. A P P R O P R I A T E - U S E C R I T E R I A Appropriate-use criteria exists to help determine when Mohs surgery should be performed. These criteria include tumor sites on the face, scalp, neck, hands, feet, pretibial legs and genitals. If a tumor is greater than two centime- ters or on the trunk, upper or lower extremities, it also a candidate for Mohs surgery. If the cancer is in areas out- side of these areas, it qualifies for a re-excision with clini- cal margins, with margins usually being between 0.4 and 1 centimeter. Margins for the Mohs procedure are initially 0.1 to 0.2 centimeters. S U R G I C A L T R A I N I N G In order to become a board-certified Mohs surgeon, the surgeon must complete the appropriate training. This train- ing begins with the completion of their undergraduate degree, medical school and a dermatology residency. Once the previ- Basal cell carcinoma