Mohs Surgery for the Treatment of Melanoma: The Gold Standard

Mohs Surgery For Melanoma

At California Dermatology and Mohs Surgery Specialists, we are proud to offer this revolutionary, state-of-the-art surgical technique to treat melanoma. We are one of the only practices in California that offer advanced Mohs Surgery with immunostaining to treat both in-situ and invasive melanomas, and are one of the only practices in California to offer advanced immunohistochemical staining including MART-1 and SOX-10 antibody staining during surgery for melanoma treatment.

 Our founder and director, Dr. Teo Soleymani, MD, FAAD, FACMS, is a nationally-acclaimed and highly-regarded expert in Mohs Micrographic and Reconstructive Surgery, including Mohs Surgery for the treatment of melanoma. Notably, Dr. Soleymani was the first and only fellowship-trained Mohs Surgeon in all of Southern California to have formal fellowship training in this state-of-the-art technique, which was pioneered by his fellowship director Dr. John Zitelli, MD, FAAD, FACMS.  As a result of his training, expertise, and skillset, he was subsequently recruited to UCLA after fellowship to introduce advanced Mohs Surgery for Melanoma to the greater Los Angeles area, where he developed and lead UCLA’s Mohs Surgery for Melanoma program. As a result of his efforts, Dr. Soleymani received both local and national acclaim for introducing landmark and pioneering surgical treatments for complex, high-risk and challenging skin cancers and his practice quickly became a national referring center of excellence for this advanced surgical technique.

What is Mohs Surgery and how is it used to treat melanoma?

Mohs micrographic surgery (MMS) is a highly specialized and precise surgical technique that has become the gold standard of care for treating skin cancers including melanoma, a type of skin cancer that can be deadly if not caught and treated early. Mohs Surgery is a surgical oncologic technique  developed in the 1930s by  the legendary general surgeon Dr. Frederic Mohs in Madison, Wisconsin. It is a specialized surgical technique that allows for the precise removal of cancers such as melanoma while minimizing the loss of healthy tissue as the technique examines 100% of the surgical margin under a microscope right at the time of surgery to determine if any cancer cells remain. This process is repeated until all cancerous cells have been removed. The key to the success of Mohs surgery is that 100% of the surgical margin is evaluated under the microscope, compared to traditional wide local excision, where less than 1% of the surgical margin is ever evaluated. Here at California Dermatology and Mohs Surgery Specialists, we are proud to be world leaders in Mohs Micrographic Surgery; our nationally-acclaimed and highly regarded, fellowship-trained Mohs Surgeon Dr. Soleymani brings his expertise, training and surgical skills to offer our patients the latest Mohs Surgery techniques.

Melanoma is a type of skin cancer that arises from pigment-producing cells called melanocytes. It is one of the most aggressive forms of skin cancer and can spread quickly to other parts of the body if not caught and treated early. Melanoma is the leading cause of death from skin disease, and it is estimated that over 200,000 new cases of melanoma are diagnosed each year in the United States alone.

Traditionally and historically, melanoma has been treated with wide excision, a surgical procedure in which the cancer is removed along with a broad margin of surrounding healthy tissue. This approach has been practiced for many years for early-stage melanoma. However, it has a high recurrence rate, particularly for melanomas that arise on the head and neck and chronically sun damaged areas, and that is because the margin of surrounding healthy tissue that is taken during wide excision is taken with the naked eye, which makes it impossible to see if any microscopic cancerous cells have extended beyond that margin. In addition, when the wide excision specimen is sent to pathology, traditional tissue processing techniques by pathology labs do not have the ability to check 100% of the surgical margin. As such, wide excision of melanomas, particularly those that arise on the head and neck and chronically sun damaged areas have been historically fraught with high recurrence rates and poorer outcomes. Mohs micrographic surgery, with the use of advanced immunohistochemical staining, takes the “guess work” out by checking 100% of the margin right at the time of surgery, allowing for much higher  cure rates, and as a result, a better survival for melanomas including in-situ and invasive melanoma.

What are the advantages of Mohs Surgery for Melanoma over Traditional Surgery?

There are several critical advantages and benefits to using Mohs Surgery for the treatment of melanoma. First and foremost, Mohs Surgery for Melanoma offers a much higher cure rate than traditional or regular wide local excision surgery, and as a result, offers better survival for patients who have melanoma. Mohs Surgery for Melanoma allows for the most accurate and precise removal of cancerous cells, which can be especially important in functionally and cosmetically sensitive areas such as the face. By removing precise, thin layers of tissue and examining them under a microscope right at the time of surgery, the expert fellowship-trained surgeon can ensure that all cancerous cells have been removed and that the margins are clear, right then and there, before any reconstruction is performed.  As a result, this can help reduce the risk of the melanoma coming back or recurring after surgery, and this advantage using Mohs technique has been demonstrated in several important published studies.

In addition to its precision, Mohs Surgery can also be less invasive than traditional wide excision surgery. Because it involves the removal of thin layers of the tissue rather than a large chunk of skin, Mohs Surgery can result in more minor scars and a faster recovery time. This can be especially important for melanoma on visible areas of the body, such as the face, where scarring can be more noticeable.

Another benefit of Mohs Surgery is that it allows for the preservation of healthy tissue. By removing thin layers of tissue and examining them under a microscope, surgeons can identify and remove cancerous cells while leaving as much healthy tissue intact as possible. This can help to reduce the risk of complications and improve the cosmetic outcome of surgery.

Conclusion

In summary, Mohs surgery for Melanoma is an excellent and highly effective treatment option and has become the gold standard of care for treatment of melanomas arising on the face, head, neck and other sun damaged areas. Additionally, advanced immunohistochemical staining utilizing the MART-1 and other melanoma specific antibody stains is an essential aspect of this treatment’s success.  Mohs Surgery for Melanoma offers higher cancer cure rates that are 5-20x better than traditional wide local excision or staged excision, and as a result, offer patients an improved overall survival benefit compared to traditional surgery. Here at California Dermatology and Mohs Surgery Specialists, we are proud to be considered world-wide leaders in advanced Mohs Surgery for Melanoma, and our surgical director, Dr. Teo Soleymani, MD, FAAD, FACMS, was the first and only fellowship-trained Mohs Surgeon in all of Southern California to have formal fellowship training in this state-of-the-art technique including formal training in  Mohs Surgery for Melanoma, advanced MART-1 staining, and advanced immunostaining during Mohs Surgery.  As a result, our practice has become a national referring center of excellence for this advanced surgical technique. California Dermatology and Mohs Surgery Specialists is proud to be one of the only clinics in California to offer Mohs for melanoma and one of the only clinics in California that utilizes advanced immunohistochemical staining to treat melanoma and other high-risk skin cancers.