Mohs Micrographic Surgery: A Revolutionary Approach to Skin Cancer Treatment

#Skin cancer, #basal cell carcinoma, #Mohs Micrographic Surgery, #screening, #dermatologist

Mohs Micrographic Surgery (MMS) is a highly specialized surgical technique used to treat skin cancers, particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Developed by Dr. Frederic Mohs in the 1930s, MMS has revolutionized the treatment of skin cancer, offering unparalleled accuracy, effectiveness, and cosmetic outcomes.

History of Mohs Micrographic Surgery

Dr. Frederic Mohs, a renowned dermatologist, pioneered MMS in the 1930s. Initially, the technique involved using a zinc chloride paste to fix the tissue, allowing for serial sectioning and examination. Over the years, MMS has evolved, incorporating advancements in microscopy, histopathology, and surgical techniques. Today, MMS is widely regarded as the gold standard for skin cancer treatment.

Principles of Mohs Micrographic Surgery

MMS combines surgical excision with microscopic examination, ensuring complete removal of cancerous tissue while preserving healthy tissue. This involves:

1. Surgical excision of the visible tumour
2. Processing and sectioning of the tissue
3. Microscopic examination of the sections
4. Mapping of the tumour margins
5. Repeat excision and examination until clear margins are achieved

Indications for MMS include

1. High-risk tumours (aggressive subtypes, large size, or location)
2. Recurrent tumours
3. Tumours in cosmetically sensitive areas (face, hands, feet)

Benefits of Mohs Micrographic Surgery

MMS offers numerous benefits, including:

1. High cure rates (up to 99% for primary BCC)
2. Minimal tissue removal, preserving cosmetic appearance
3. Reduced risk of recurrence
4. Improved accuracy, reducing the need for additional surgeries
5. Enhanced patient comfort and satisfaction (Performed in an outpatient setting with local anaesthesia. The removal of cancer and repair of the wound is all undertaken in the same day)

Applications of Mohs Micrographic Surgery

MMS is primarily used to treat:

1. Basal cell carcinoma (BCC)
2. Squamous cell carcinoma (SCC)
3. Other rare skin cancers (e.g., Merkel cell carcinoma)

How is Mohs Micrographic Surgery different from conventional cancer removal surgery aka Wide Local Excision?

Mohs Micrographic Surgery (MMS) and Wide Local Excision (WLE) are two surgical techniques used to treat skin cancer. Here are the main differences:

Conclusion

Mohs Micrographic Surgery has transformed the treatment of skin cancer, offering unparalleled accuracy, effectiveness, and cosmetic outcomes. Its evolution over the years has solidified its position as the gold standard for skin cancer treatment in critical skin sites. As skin cancer incidence continues to rise, the importance of MMS in modern dermatological practice cannot be overstated. Patients and healthcare professionals alike can rely on MMS to provide the best possible outcomes for skin cancer treatment.

#sensitiveskin, #skincare, #dermatology, #dermatology, #eczema #acne

Moisturizers are an essential component of any skincare routine. Rather than an entity with a singular ingredient, moisturizers combine distinct skincare components to provide that soothing and hydration feel to your skin.

3 important components combine to form a good moisturizer.

• Emollients
• Humectants
• Occlusives

These components can also have overlapping properties, providing synergistic improvements in the skin.

Imagine a brick wall with skin cells being individual bricks ….

1. Emollients

   Akin to the cement between bricks, emollients are ingredients that fill gaps between skin cells, making skin feel smooth, soft, and supple. They help maintain and restore the skin’s barrier function. Additionally, they strengthen the skin barrier protection against environmental stressors.

   Examples of emollients:

   Natural Emollients_

   • Oils (coconut, olive, jojoba)
   • Fatty acids (ceramides, omega-3)
   • Waxes (beeswax, carnuba)

   Synthetic Emollients

   • Dimethicone
   • Cyclomethicone
   • Phenyl trimethicone
2. Humectants

   Much like limestone bricks- a unique quality of humectants is their ability to absorb and attract water. They retain moisture from the surrounding air, drawing water into the skin. They help maintain the skin’s natural moisture balance and can leave skin feeling hydrated and plump. They further reduce the appearance of fine line and wrinkles, and are calming to dry, sensitive, or irritated skin.

   Examples of humectants:

   Natural Humectants

   • Honey
   • Glycerin
   • Sorbitol
   • Xylitol

   Synthetic Humectants

   • Hyaluronic acid
   • Sodium hyaluronate
   • Panthenol
   • Betaine

   The third piece of the puzzle (or brick wall)!

3. Occlusives

   Occlusives are ingredients in skin moisturizers that work like top coats on walls. They help prevent moisture loss by forming a physical barrier on the skin’s surface. In so doing, it prevents water from evaporating (Transepidermal water loss- TEWL), keeping skin hydrated for longer.

   It also supports the skin’s barrier function and reduces irritation.

   There are different types of occlusives. Physical occlusives form a visible, physical barrier on the skin’s surface, like a film. Examples include petrolatum. Lipid occlusives help repair and restore the skin’s natural lipid barrier. A good example includes ceramides.

   Occlusives can be especially beneficial for patients looking for longer lasting hydration and protection. It is useful for dry, sensitive, or compromised skin, especially in skin conditions like eczema and psoriasis. A good occlusive is also useful for skin exposed to harsh environments.

   However, some occlusives can also leave a greasy or heavy finish, and interfere with the skin’s natural excretory processes, leading to comedogenesis or acne breakouts. In addition, certain occlusives e.g. lanolin have been known to trigger a contact reaction in sensitive individuals, leading to red, flaky and inflamed skin.

   Examples of occlusives:

   Natural Occlusives

   • Beeswax
   • Lanolin
   • Coconut oil
   • Shea butter

   Synthetic Occlusives

   • Petrolatum (Vaseline)
   • Dimethicone
   • Cyclomethicone
   • Phenyl trimethicone

   Plant-Derived Occlusives

   • Carnuba wax
   • Candelilla wax
   • Rice bran wax

In summary

• Emollients smoothen and repair the skin’s surface
• Humectants attract and retain moisture
• Occlusives retain skin moisture and reinforce the natural skin barrier
• Moisturizers combine emollients, humectants, and occlusives to provide complete hydration and protection.

Final tips

When choosing a moisturizer, consider 4 main aspects of your skin

• Skin type
• Skin concerns (e.g. acne, eczema)
• Formulation and texture on the skin
• Hypo allergenicity

By understanding the intricacies of these components, you can make informed decisions to support your skin’s unique needs and achieve healthy, radiant skin!