Excision or Micrographic Surgery: Modern Techniques for Treating Melanoma

May 7th 2016

Mohs micrographic surgery offers a promising alternative to conventional excision for certain melanomas. However, there are no current studies that examine recurrence rates using a proper random selection of treatments, so it is not yet possible to say if it is a better treatment overall. Talk to your doctor to get her opinion and judge the facts for yourself before committing to any surgery.

Standard Excision

Standard excision of a melanoma involves cutting away all of the visible tumor along with a margin of normal tissue. This includes tissue under the tumor, which may involve subcutaneous fat and muscles. Many surgeons are highly experienced with this type of surgery, and it is often a relatively quick operation.

Mohs Micrographic Surgery

Micrographic surgery excises the visible tumor and a small margin of skin. The sample is then immediately examined microscopically. The trained surgeon extrapolates from the data the likely location of any additional tumor cells and removes further thin layers from those precise regions until investigation gives an all clear.

Pros and Cons

Standard excision is performed by more surgeons, so you do not have to wait as long for an appointment. However, analysis of the tissue cut away is not done until well after the operation, and then only around 1 percent is analyzed. This means further mutated cells can be missed or their treatment delayed. With Mohs micrographic surgery, the analysis is done on the same day, and the wound has not begun to heal before any further required work is done, minimizing scarring. Mohs technique also results in a smaller surgical wound in some cases.

Conclusion

Early and effective treatment for skin melanomas is vital to ensure cancer cells do not spread to other vital systems. This usually involves removing the carcinoma, but there are multiple ways to do this treatment.

Sources

Dermatology.UCSF.edu "Mohs micrographic surgery--How it works" http://www.dermatology.ucsf.edu/skincancer/mohs.aspx
Cochrane.org "Mohs micrographic surgery versus surgical excision for periocular basal cell carcinoma" http://www.cochrane.org/CD007041/EYES_mohs-micrographic-surgery-versus-surgical-excision-for-periocular-basal-cell-carcinoma

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