Mohs Surgery for Skin Cancer

Think about this: Your chance of developing a nonmelanoma skin cancer in your lifetime is about one in five. What’s more, rates of these basal and squamous cell cancers are on the rise as baby boomers with sun-damaged skin are getting older.

But there’s good news: Eisenhower Medical Center is home to a new skin cancer clinic headed by Board Certified Dermatologist Keyan Matinpour, MD, who is fellowship-trained in Mohs surgery — the gold standard for treating high-risk, non-melanoma skin cancers. Dr. Matinpour completed an American College of Mohs Surgery (ACMS) approved fellowship in micrographic surgery and dermatologic oncology.

“Mohs surgery offers the highest cure rate, lowest recurrence rate and best cosmetic results of any skin cancer treatment we have today,” says Dr. Matinpour who joined Eisenhower in July after completing a one-year fellowship with world-renowned Mohs surgeon Leonard Goldberg, MD, at Houston Methodist Hospital. Used to treat basal and squamous cell cancers, this surgical approach is especially beneficial for removing lesions on “sensitive real estate” like the nose, lips, ear, eyelid and other parts of the face.

“In traditional excisional surgery, the surgeon draws a circle around a lesion; this circle is 4 millimeters away from the visible edges of the lesion,” Dr. Matinpour explains. “The surgeon cuts out that tissue and sends it to the pathology lab, hoping the margins are clear. Sometimes they’re not, which means the patient has to return for additional surgery since you often don’t know the results for days.

“Plus, chances are that a lot of normal tissue has been removed along with the lesion, which increases scarring,” he adds.

The Mohs procedure is much more precise, with the surgeon taking only as much tissue as is absolutely necessary. It’s performed using local anesthesia. And the laboratory examination of the tissue sample is done immediately.

“Using a scalpel, I take the thinnest possible layer of visible cancerous tissue with a 1 millimeter margin,” says Dr. Matinpour. “This sample is color-coded with dyes so we can map exactly where it was removed from the patient’s body.”

In the clinic’s onsite lab, a specially trained technician freezes the tissue, cuts it into ultra-thin slices and mounts it on slides. The tissue on the slides is stained, and Dr. Matinpour examines the slides under a microscope, all while the patient remains in the clinic.

“If I see any remaining cancer, I can pinpoint where I need to remove more tissue in another thin layer,” he continues. “We repeat this until the edges, the margins of the final tissue sample, are clear.”

The Mohs procedure can take from about 90 minutes, if only one layer of tissue needs to be removed, to several hours, if multiple layers require excision. “Every time you take another layer, it adds 30 to 45 minutes,” Dr. Matinpour notes.

But the extra time translates into the best possible outcome.

“Because we examine 100 percent of tissue margins under the microscope, the cure rate using Mohs surgery is over 98 percent,” Dr. Matinpour says. “This approach also conserves the most healthy tissue, so scarring is minimized.

“Of course, preventing skin cancer in the first place is the best approach of all,” he adds (see sidebar for his advice on skin cancer prevention). “But Mohs surgery offers the best chance for a cure when it does occur.”

Eisenhower Dermatology and Mohs Center focuses entirely on the prevention, diagnosis and treatment of skin cancer, providing a complete spectrum of today’s most advanced technologies and therapies, including Mohs micrographic surgery. Patient education is also an integral part of the Clinic’s services. For more information, please call 760-837-8542.

Shedding light on skin cancer prevention
“I wish I had a time machine and could travel back in time to tell baby boomers how to protect themselves from the skin cancer that so many are getting today,” says Board Certified Dermatologist and Mohs micrographic surgery specialist Keyan Matinpour, MD.

“First and foremost, limit sun exposure,” he says. “Don’t be out during peak hours between 10 a.m. and 3 p.m., wear protective clothing like long-sleeves and a wide-brimmed hat if you must be out, and seek the shade. “Be religious with sunscreen,” he continues. “You can’t apply it just once before going out; to really protect yourself, you need to reapply it as often as once an hour if you’re sweating or swimming.

“And don’t burn!” he stresses. “Melanoma — the deadliest form of skin cancer — is related to intermittent sunburns. The CEO who vacations in Aruba, and gets sunburned a couple of times a year, is more likely to get melanoma than someone who works in the sun every day. Cumulative sun damage is bad enough, leading to basal and squamous cell cancers and premature aging of the skin, but an occasional burn can be truly dangerous.

“We’re also seeing a higher incidence of melanoma in younger people in their twenties to forties, and it’s linked to tanning bed use,” he adds, noting that the state of California is adopting new laws to regulate the age at which people can use tanning beds.

Who’s most at risk of getting skin cancer?

“People who are fair-skinned with light eyes, and those with a family history of skin cancer are at higher risk,” Dr. Matinpour says. “If you have certain autoimmune diseases, such as lupus, or are taking medication that compromises the immune system, it increases your risk.

“And desert-dwellers are at risk because their exposure to ultraviolet (UV) light is significantly higher with our 350-plus days of sunshine,” he adds. “Use that sunscreen!”