Amanda Wilde (Host): There is a highly effective treatment for skin cancer called Mohs surgery. Dermatologist and Mohs surgeon, Dr. Justin McLawhorn, explains next.

This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Amanda Wilde. Dr. McLawhorn, welcome. Thank you for being here.

Dr. Justin McLawhorn: Hi, thank you. Thank you so much for having me.

Host: Well, Mohs surgery, I only know it's highly effective. I've read that it's 99% effective. Is that true? And tell us about what that is, Mohs surgery.

Dr. Justin McLawhorn: Yes, you are correct, as a majority of cases can actually be cured with rates that have been published higher than 99%. Mohs surgery is the most effective way to treat the two most common types of skin cancers, and those are basal cell and squamous cell skin cancers. It's highly effective, allowing us to remove the smallest amount of skin in order to completely remove a cancer, particularly on areas of the head and neck. This allows us to ensure that we can completely cure the cancer, but also to give you the best cosmetic outcome possible.

Host: . So, not only does it have such a high effectiveness rate, it also sounds like the least invasive of what you could do to treat skin cancer. Is that right?

Dr. Justin McLawhorn: That is correct. It is a very minimally invasive procedure that involves minimal downtime, and the procedure itself from start to finish can be done in just a matter of a few hours.

Host: How do doctors determine if Mohs surgery is appropriate for a particular individual?

Dr. Justin McLawhorn: We actually have a tool that's available for us called the Mohs Appropriate Use Criteria. And with a simple app, we can type in some tidbits of information and this information spits out a score that can tell us if a particular patient and if a particular type of cancer was appropriate for Mohs surgery.

Host: And would Mohs be your first choice if it applies?

Dr. Justin McLawhorn: Mohs surgery is the standard of care for some of the most common skin cancers, and that would be the primary treatment for many of those that are on the head and neck.

Host: Let's talk about the Mohs surgery itself. How long does it take? Are you awake for the procedure? What kind of anesthesia is used?

Dr. Justin McLawhorn: So, Mohs surgery itself can take as few as an hour or two. It can last a little bit longer, per se, if the particular cancer is one that's just a little bit larger than what's anticipated. One of the things that I always counsel my patients in regarding Mohs surgery is that we really never know how long or how small or how large a cancer is or how long it takes to treat it, that is, just because we never truly know the extent of the cancer growth until we are inside looking at the skin. But for many of our patients, it just takes a couple of hours, and that also includes the repair after the procedure.

The anesthesia that's used is what we call local anesthesia. That's numbing medicine that's delivered into and around the cancer itself to put the skin to sleep. The patient is not asleep, but rather the skin is. And this allows us to perform the surgery while you're comfortable in ensuring that we keep this minimally invasive as we possibly can.

Host: Once the procedures completed, how long is the recovery period?

Dr. Justin McLawhorn: The recovery period can vary from person to person and from cancer to cancer. Often times, the recovery period may just be a few days. Sometimes for more extensive repairs or larger cancers, it can last for a period of weeks. Regardless of how long it lasts, you can rest assure that I and my team will be available to help you along the way.

Host: And we already talked about the high success rate of Mohs surgery for the most common cancers. Are there any potential risks? Or is there any other time you would use a different surgery?

Dr. Justin McLawhorn: There's inherent risk to any time we operate or perform surgery. For Mohs surgery, the inherent risks are very small, but nonetheless, mentionable risk for cancer coming back; pain with the numbing medicine, bleeding from the procedure, which we can control; scarring and infection, which likewise we attempt to minimize and control.

There are cases in which Mohs surgery may not be the most appropriate. And this is an active area of advancement in the field of Dermatology and Mohs surgery, and that's the treatment of melanoma. So, melanoma at this point, the standard of care is a standard excision, which I as a Mohs surgeon also do.

But the type of procedure that's done for the removal of melanoma is a procedure that takes a little bit longer than Mohs surgery. Mohs surgery has the advantage that you know that when you come for treatment, the cancer itself is going to be completely treated and removed. With the melanoma treatment, it may take a few days or a few weeks in order to completely process the edges of the skin tissue that's removed in order to ensure that the cancer's been completely removed. And that's because it requires special stains that are not yet widely used and implemented in Mohs surgery. However, this again is an active area of research. And hopefully, we can see this implemented more and more into our practice as time draws closer to it.

Host: I was just going to ask if you see any further advances made in this surgery, because it's already so amazingly high in its success rate and its recovery

Dr. Justin McLawhorn: Yeah. So, I think that the biggest advance that's being made in Mohs surgery is the combination use of immunohistochemistry. And these are the special stains that I was referring to earlier in order to help detect the nuanced differences between cancer cells, such as the melanoma cancer cells from the normal-appearing cells. That's one of the limitations of Mohs surgery, is that we rely on a particular type of tissue-processing technique that's what it is called frozen tissue, whereas the standard type of excision technique relies on permanent section. And permanent section can sometimes give us greater contrast between what's called the normal cells and the cancerous cells.

But we are finding ways to implement this immunohistochemistry in order to highlight the cancerous cells in melanoma and those alike, in order to help guide our treatments, and in order to ensure that we achieve completely negative margins using this fresh frozen tissue technique, which is great for the patient because we still have excellent cure rates, and it cuts down the time that is required in order to achieve these clear margins. Therefore, it makes the patient more appreciative and not having to manage a surgical wound for a longer period of time.

Host: Yeah, it certainly sounds very cutting edge to me, even though the surgery has been around a while and it sounds like you will have even more precision as time goes on.

Dr. Justin McLawhorn: Yes, absolutely. I'm looking forward to seeing what becomes available for us here within the next 10 to 15 years in terms of how we implement this into our practice. I think that we can start to see more and more tumors becoming treated with Mohs and even becoming the standard of care, but that is on the horizon. I'm looking forward to seeing it.

Host: Yeah. Such great progress made in the treatment of skin cancers, which seem to be pretty common. So, thank you for explaining Mohs surgery, Dr. McLawhorn.

Dr. Justin McLawhorn: Absolutely. I'm happy to do it.

Host: That was dermatologist and Mohs surgeon, Dr. Justin McLawhorn. To make an appointment at the UAMS Dermatology Clinic, please call 501-686-5960. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for other topics of interest. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences.