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Rethink Mohs Surgery

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If you’ve been diagnosed with non-melanoma skin cancer (NMSC), you may want to rethink Mohs Surgery- the standard-of-care.  All therapies have risks and benefits, pros and cons. The key is to fully understand both.

The articles linked and excerpted below do a pretty good job of explaining:

  • What Mohs surgery is-
  • What the risks of Mohs surgery are-
  • And why you might want to rethink Mohs surgery-

I am a cancer survivor struggling with a host of long-term and late stage side effects caused by my aggressive cancer therapies (not skin cancer). So I often write about “deintensifying treatment” of all cancers.

In order to rethink Mohs surgery, you may want to consider:

  • your diagnosis of NMSC (how aggressive is the skin cancer?),
  • you may want to think about the possible risks of this procedure,
  • you will want to think about your life expectancy and
  • you will want to understand the costs involved with this procedure. 

I don’t want to sound negative toward conventional oncology but in my experience oncologists don’t  do a thorough job of explaining the negatives surrounding a procedure that they want to perform.

man hand holding his nutritional supplemets, healthy lifestyle background.

Have you been diagnosed with non-melanoma skin cancer? To learn more about nutritional supplementation shown to reduce your risk of NMSC relapse, email me at David.PeopleBeatingCancer@gmail.com

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

What Is Mohs Surgery?

“The goal is to remove as much of it (the NMSC) as possible while saving the healthy tissue around it. Layers of skin are removed one at a time and examined under a microscope until all the cancer is gone. This reduces the chance of needing future treatments or surgery.

“What Are the Risks?

Mohs surgery is generally considered very safe, but there are some risks:

  • Bleeding from the site of surgery
  • Bleeding into the wound (hematoma) from surrounding tissue
  • Pain or tenderness in the area where skin was removed
  • Infection

Although these are less likely to happen, there are other potential problems:

  • You could have temporary or permanent numbness in the area where the skin was removed.
  • If your tumor was large and your surgeon cut a muscle nerve while removing it, you might feel some weakness in that part of your body.
  • You might feel itching or shooting pain.
  • You could develop a thick, raised scar.

Managing Skin Cancer in an Aging Population: Rethinking the Role of ‘Gold Standard’ Surgeries

“These questions are becoming increasingly urgent as the incidence of skin cancer, especially NMSC, rises in the older adult population, especially in patients older than 85 years…

“Sometimes we lose track of what…we need to do” to provide care that reflects the best interests of the older patient, he continued. “Surgery may be the gold standard for treating the majority of NMSCs…but is it the [best option] for what our older patients and patients with limited life expectancy need?…”

By 2040, projections are that the number of adults aged 85 years and older in the United States will be nearly quadruple the number in 2000, according to one estimate…

NMSC Increasing in the Older Population

The incidence of skin cancer is rising faster than that of any other cancer, Patel said. One window into the epidemiology, he said, comes from recently published data showing that an average of 6.1 million adults were treated each year for skin cancer during 2016-2018 (5.2 million of them for NMSC) — an increase from an average of 5.8 million annually in the 2012-2015 period…

As a frame of reference, the average number of adults treated each year for nonskin cancers during these periods rose from 10.8 to 11.9 million, according to the 2023 MEPS data. “Skin cancer is about one third of all cancers combined,” Patel said…

“What’s interesting and worth thinking about is that regardless of patients’ life expectancy, NMSCs were treated aggressively and surgically, and the choice of surgery was not influenced by the patient’s poor prognosis in a multivariate model” adjusted for tumor and patient characteristics, he said at the meeting…

The researchers defined limited life expectancy as either 85 years or older or having a Charleston Comorbidity Index ≥ 3. Approximately half of the patients with limited life expectancy died within 5 years, none of NMSC. Most patients with limited life expectancy were not often bothered by their tumors, and approximately one in five reported a treatment complication within 2 years. The 5-year tumor recurrence rate was 3.7%…

Granted, [the reasons] are justified indications for surgery,” Patel said. Yet the study brings up the question of “whether we need to do Moh’s surgery this frequently in elderly patients?” In an email after the meeting, he added, “it’s a question we may need to reconsider as the elderly population continues to increase and median age of NMSC rises.”…

Underutilized Management Options for NMSC

In his practice, discussions of treatment options are preceded by a thorough discussion of the disease itself. Many lesions are low risk, and helping patients understand risks, as well as understanding what is important to the patient — especially those with limited life expectancy — will guide shared decision-making to choose the best treatment, Patel said at the meeting.

The dermatologist’s risk assessment — both staging and stratifying risk as it relates to specific outcomes such as recurrence, metastases, or death — takes on added importance in the older patient, he emphasized. “I think we underutilize the risk assessment…”

Also underutilized is the option of shave removal for low-risk squamous cell carcinomas and basal cell carcinomas, Patel said, noting that in the National Comprehensive Cancer Network guidelines, “there’s an option for shave removal and nothing more if you have clear margins…”

Also important, Patel noted, is the big-picture consideration of skin cancer treatment costs- which may make you rethink mohs surgery. The MEPS survey data showing the rising prevalence of skin cancer treatment also documented the economic burden: A nearly 30% increase in the average annual cost of treating NMSC from $5 billion in 2012-2015 to $6.5 billion in 2016-2018. (The average annual costs of treating melanoma decreased slightly.) “Skin cancer is a big drain on our limited resources,” he said…”



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