Mohs Skin Cancer Surgery

Jessica Lovell: In our morning rounds today, First Lady Dr. Jill Biden underwent surgery this week after doctors found a small lesion above her right eye. It was found during a routine skin cancer exam. The procedure is known as Mohs surgery and we want to bring in Dr. Jessalyn. Tate, director of dermatologic surgery and Mohs micrographic surgery. Dr. Tate good morning to you. Exactly what is Mohs surgery and is it pretty routine?

Dr. Jesalyn Tate: Good morning. Yes. So Mohs surgery is a specialized skin cancer removal technique. Not every cancer is going to qualify for Mohs surgery or needs Mohs surgery. But whenever we do it, it's really for those cancers in the cosmetically sensitive areas or the areas where we don't have a lot of extra skin. And so with it, what we do is we numb people up just like they did for their biopsy at the time of diagnosis. And then we remove that skin cancer, and we take a very narrow margin with Mohs surgery, so we're able to save that normal healthy skin. And then we process that in our lab, we freeze that we stain it and I look at it underneath the microscope, and we make sure all those skin cancer cells are gone. And we keep going with that process until the patient is cancer free and there is no more cancer cells remaining. As soon as we're done there, then we get the patient back together. And so Dr. Jibbe is our other Mohs surgeon. And of course myself were trained in cosmetic reconstruction as well after Mohs surgery, so making sure patients get a good long term outcome.

Jessica Lovell: So Dr. Tate during the First Lady's preop screening, there was a second area on her chest that looked kind of concerning doctors removed it and found it was basal cell carcinoma. So does that mean that Dr. Jill Biden has skin cancer? Because that sounds serious. Are there further concerns?

Dr. Jesalyn Tate: Yeah, great question. So yes, basal cell carcinoma is a subtype of skin cancer or type of skin cancer, I should say. It's actually the most common type of skin cancer, we see it very, very commonly. It's one of the, definitely the most common that I treat. And you know, the good thing about basal cell it's a low-risk skin cancer as far as things go, it's not kind of scary when we hear about the spreading and metastasis and all those scary things we hear about with melanoma, basal cell's generally low risk, however, it can be locally invasive. So we want to make sure we get that skin cancer out with clear margins, just to make sure it doesn't cause the patient long term problems.

Jessica Lovell: You and I were talking before the the program that I told you that I had Mohs surgery because I had basal cell right smack dab in the middle of my chest, very noticeable. That was about 10 years ago, when I had Mohs, I'd never heard of it, actually. But I thought, hey, if that's what we got to do to get rid of it, let's do it. So has it advanced at all in that last decade? Or is it just more common and people are more aware of it?

Dr. Jesalyn Tate: Yeah, a little bit of both. So definitely, it's more well known, I think as a skin cancer treatment. There's more fellowship trained Mohs surgeons now in the country, then there were 10 years ago. So I think the importance of fellowship training with Mohs surgery has been really well recognized and, and knowing that your doctor has really been trained to do your skin cancer removal, and to do your reconstruction. And so I would say in ways the core process of Mohs surgery hasn't changed in the last 10 years. I don't think it's changed in the last 30 years. But I will say we're treating more cancers than ever before with Mohs, we're using immuno stains now to treat melanoma and other rare cancers. So I think it's becoming more widely available, more well known, more recognized. But also I think we're advancing our techniques with treating more rare or more challenging skin cancers.

Jessica Lovell: Skin cancer screenings, it's year round for you, and certainly for all of us. But as we start getting ready to think about spring and getting out in the sun more often and planning those trips out in the sunshine, just give us some warnings, what we need to think about and certainly just a good reminder about getting screened and getting our skin checked.

Dr. Jesalyn Tate: Yeah, so I think you know, if you're in your 20s, 30s, and you haven't had a baseline skin check, I highly recommend it. I think it never hurts to get your skin checked when you're younger. And especially if you're older than that, definitely set yourself up for a good checkover. You know, with a board-certified dermatologist, you're getting the best care, you're getting really a good close look at all of your skin lesions, making sure there's nothing to worry about. And then for each patient, it's different. We say hey, we don't need to see you back for a few years for another check. Or sometimes we want to see them back really frequently depending on how high risk they are for skin cancer and we kind of make that determination based on the patient's age, sun exposure, and what we see whatever we look at their skin.

Jessica Lovell: Okay, I'm maybe a couple of months past my year exam. I'm very good about getting it so I'm gonna make a note and I will make my appointment I promise Dr. Tate when I get off the air. Okay, I'll come see your team. Thank you so much for being with us this morning. Good to see you.