Mohs micrographic surgery stands as a highly effective treatment for many skin cancer types. Despite its precision, individuals often wonder if skin cancer can return following Mohs surgery.
The Efficacy of Mohs Surgery
Mohs micrographic surgery is a specialized procedure for removing skin cancer, particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). This technique involves the layer-by-layer removal of cancerous tissue, with each layer immediately examined under a microscope. The surgeon continues to remove thin layers until no cancer cells are detected at the margins, ensuring complete tumor removal while preserving healthy tissue.
This meticulous approach contributes to high success rates. For primary BCC and SCC, cure rates can reach up to 99%, and for recurrent skin cancers, success rates are around 94%. The thorough microscopic examination during the procedure minimizes the chance of leaving cancerous cells behind.
Understanding Recurrence After Mohs
While Mohs surgery boasts impressive cure rates, recurrence, though rare, is possible. One type is a true recurrence, where a microscopic cancer cell was missed, allowing the original tumor to regrow. This is infrequent given Mohs surgery’s comprehensive margin control.
Another scenario involves a new primary cancer developing in the same general area, distinct from the originally treated lesion. This often occurs due to widespread sun damage, known as field cancerization. Individuals with a history of skin cancer are at higher risk of developing another, either in a different location or a new tumor in the same region. Certain aggressive skin cancer subtypes, like Merkel cell carcinoma, also have a higher recurrence propensity, with rates ranging from 20-30% after Mohs surgery.
Patient-specific factors also influence recurrence likelihood. Individuals with compromised immune systems, such as organ transplant recipients or those on immunosuppressive medications, face an increased risk for certain skin cancers, especially squamous cell carcinoma. The size and location of the original lesion can also play a role. Recurrence rates for basal cell carcinoma after Mohs surgery are low, 1% to 2% for primary tumors, and for squamous cell carcinoma, local recurrence rates are around 2.5%.
Signs of Recurrence and Next Steps
Recognizing potential signs of skin cancer recurrence is key. A new bump or nodule at or near the treated surgical site could indicate recurrence. Changes in the scar, such as increased redness, tenderness, persistent itching, or bleeding, also warrant attention. Any non-healing sore or persistent changes in the treated area should prompt concern. While most recurrences appear within the first two years, late recurrences are possible.
Regular self-skin exams aid early detection. Routinely inspect the Mohs surgery area. If suspicious changes are observed, contact a dermatologist for evaluation.
Should a recurrence be confirmed, further treatment options are available. These may include re-excision, potentially another Mohs procedure, or other modalities like radiation therapy. For more widespread recurrences, systemic treatments might be considered. Early detection allows for the most effective and least invasive treatment options.
Long-Term Monitoring and Prevention
Ongoing vigilance is important after Mohs surgery to maintain skin health and detect new or recurring skin cancers. Regular follow-up appointments with a dermatologist for full-body skin examinations are recommended. These appointments typically occur every 3 to 12 months for several years, depending on individual risk factors and the type of skin cancer treated. This consistent monitoring aids early detection of new skin cancers or potential recurrences.
Beyond professional examinations, adopting protective habits prevents future skin cancers. Consistent sun protection should be a daily practice. Apply broad-spectrum sunscreen with an SPF of 30 or higher to all exposed skin, even on cloudy days, reapplying every two hours when outdoors. Wear protective clothing, such as wide-brimmed hats and long-sleeved shirts, and seek shade during peak sun hours. Avoiding tanning beds reduces the risk of developing new skin cancers.