A tissue-sparing surgical technique may now benefit patients with a hard-to-treat type of melanoma. The technique, called Mohs surgery, has traditionally been used for the less dangerous mon-melanoma skin cancers. Carl Washington, M.D., and Diamondis Papadoupoulos, M.D., dermatologic surgeons at Emory University's Winship Cancer Center, are studying the use of Mohs surgery for lentigo-maligna melanoma.
Lentigo-maligna tumors, just one of several types of melanoma, tend to be large and occur in cosmetically important areas on sun-damaged skin of older people. Lentigo-maligna is the least serious type of melanoma unless it is neglected or inadequately treated. This superficial lesion may grow slowly for years, but when a phase known as vertical growth begins, the tumor can advance as rapidly as the more virulent melanomas.
The Mohs technique is generally used for basal or squamous cell skin cancers, especially those located on the eyelid, face, or head.
"Mohs is now being tested as a better way to treat lentigo-maligna because with current procedures, the tumors tend to recur," explains Dr. Washington.
The Mohs procedure requires great precision. Using a microscope to examine the tissue, the surgeon excises the growth layer by layer until only healthy tissue remains.
Melanoma is typically cut out, along with a wide margin of nearby tissue. "Since Mohs is the only method now in use that checks the majority of the surgical margins for residual tumor cells, it may provide a better chance of getting rid of the tumors and preventing them from recurring," says Dr. Washington. "At the same time, it conserves tissue."
"Other centers are experiencing good results using Mohs for this particular type of melanoma," says Dr. Washington. Mohs surgery for melanoma was first performed at Emory two years ago. Patients must be followed for five years to determine its effectiveness.