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Roslyn, NY, April 2011 – Skin cancer is on the rise, with more incidents being identified in younger people. There are more than one million cases of skin cancer diagnosed annually and The American Cancer Society estimates that one in five Americans will develop skin cancer in their lifetime. A study recently published in the American Medical Association’s Archives of Dermatology combined multiple government databases to calculate that 3.5 million cases of nonmelanoma skin cancers are diagnosed annually in the U.S., prompting its authors to declare skin cancer an “under-recognized epidemic.”

The most common type of skin cancer is basal cell carcinoma, which affects at least one million Americans a year. While rarely fatal, it’s important to treat early because basal cell carcinomas can grow, ultimately requiring larger-scale surgeries and resulting in larger scars. Squamous cell carcinoma is also common: More than 250,000 cases are diagnosed annually, resulting in about 2,500 deaths.

According to Dr. Maya Thosani, who specializes in Mohs surgery at Advanced Dermatology, P.C. in New Jersey, “both of these carcinomas can be easily treated, and one type of surgery offers patients the best odds. Mohs surgery has the highest cure rate, 99%, for these common types of skin cancer. The main difference between this micrographic surgery and other methods of removing skin lesions is microscopic control. The procedure allows the board certified dermatologic surgeon to precisely remove skin cancers without removing large amounts of normal skin.”

What happens during Mohs surgery?

During this fresh tissue technique, layers of skin which contain the skin cancer are progressively removed and examined until only cancer-free tissue remains. Doctors mark the area of clinically recognizable tumor and numb the area to be excised with local anesthetic. The tissue is surgically removed, divided, and marked with reference points on the patient. Specimens are then labeled with dyes that allow the surgeon to correlate the tissue seen on microscopic slides.

“Specialized technicians at the surgery site then produce frozen section slides of the removed tissue that is microscopically analyzed by the surgeon,” explains Dr. Aza Lefkowitz, who also specializes in Mohs micrographic surgery at Advanced Dermatology, P.C. in New York. “If any tumor remains in the resection tissue, the surgeon knows that the tumor is still in the patient. The patient then returns to the operating room for removal of another thin segment of tissue which saves the patient from getting a big scar.”

Dr. Thosani explains that traditional sectioning can sometimes leave “nests” of cancer cells behind, allowing the cancer to remain and grow. With Mohs’ mapping, the cancer would be detected and cured. According to studies by the Mayo Clinic and other institutions, Mohs surgery provides five-year cure rates exceeding 99 percent for new cancers, and 95 percent for recurrent cancers.

When is Mohs the best treatment option?

  • When the patient wants/needs to have the smallest scar, highest cure rate and a stress reliever because the results are given the same day.
  • The cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, fingers, toes, genitals
  • The cancer was treated previously and recurred
  • Scar tissue exists in the area of the cancer
  • The cancer is large
  • The edges of the cancer cannot be clearly defined
  • The cancer is growing rapidly or uncontrollably
  • When the cancer Is likely to return. Mohs micrographic surgery is more effective in obtaining cancer-free margins for cancers that have irregular borders and a history of removal and recurrence.
  • Has a high risk of spreading to other parts of the body, such as in some squamous cell carcinomas.
  • Occurs in children.

What are the cost benefits?

Studies cited in Journal Watch Dermatology comparing the costs of Mohs Surgery with those of traditional surgical methods show that Mohs is no costlier than standard excision and is less expensive than radiation therapy or excision in an ambulatory surgery center. The research also determined that non-Mohs treatments carry 5-year recurrence rates of up to 10-12% for common skin cancers and up to 50% recurrence rates for rarer skin cancers.

“Additional procedures for removal of recurrent cancers or for re-excision (in cases where part of the cancer is missed in the first excision) can be expensive,” says Dr. Lefkowitz. “Because this procedure minimizes the risk of recurrence, Mohs surgery reduces and frequently eliminates the costs and severe patient anxiety, trauma and complication of larger, more serious surgery for recurrent skin cancers.”

Dr. Lefkowitz is a summa cum laude graduate of the State University of New York (SUNY) Downstate College of Medicine in Brooklyn, where he earned his Medical Degree. Dr. Lefkowitz’s practice is primarily surgical. With his precision and expertise, he is especially well regarded for the exceptional and cosmetically elegant way in which he repairs his patients’ Mohs defects. Board certified in both Dermatology and Mohs Microsurgery, Dr. Lefkowitz has been a member of Advanced Dermatology and the Center for Laser and Cosmetic Surgery since

A graduate of Columbia University, Dr. Thosani completed a fellowship in Mohs Micrographic Surgery at the Skin Cancer Center in Cincinnati, under the mentorship of Dr. Brett Coldiron, president-elect of the Mohs College and Board member of the American Academy of Dermatology. Dr. Thosani’s research interests involve cutaneous oncology and the use of dermoscopy as a non-invasive tool for early detection of skin cancer.  She is a member of the American Academy of Dermatology, and an associate fellow of the Mohs College of Micrographic Surgery.

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