Mohs surgery for melanoma offered at Stanford Health Care

Proceeding carefully

Hollmig and his Stanford Medicine colleagues have proceeded carefully because the new processing and analysis are technically difficult. “We wanted to do things the right way,” he said. Stanford Health Care’s dermatopathology service became a crucial partner for the advanced training needed for the new procedure.

The procedure is based on a technique developed by Wisconsin surgeon Frederic Mohs in the 1930s. Mohs surgery begins with the removal, like a plug, of the most visible center of the cancer. Then, the surgeon will remove tissue around the center, in layers about 3 millimeters thick. That tissue is sliced into micron-thin pieces, stained, frozen and examined within minutes. The incremental removal of tissue means that no more will be removed than is necessary. When the cancer is near the eyelid, for instance, the precision of Mohs keeps wounds and scars, or reconstructive surgery, to a minimum.

Hollmig said he and fellow dermatologic surgeon Sumaira Aasi, MD, a clinical professor of dermatology at Stanford, expect to use the procedure to treat the increasing number of people diagnosed with melanoma. The new technique is well-suited for patients whose melanoma is in areas where sparing tissue is most critical — the head, neck, hands, feet and genitalia. With speedy analysis of cancerous tissue now available, patients can have a tumor removed and any needed wound repair completed in one day.

Ledbetter, who lives in Lodi, said she appreciated that. Her melanoma had spread through half of one side of her nose. After removing the cancerous tissue, Hollmig built Ledbetter a new nose with a procedure called a paramedium forehead flap. The flap is a section of tissue about a half-inch deep and 5 inches long surgically separated away from the forehead. One edge remains attached to the forehead, just above the eyebrow; the rectangular remainder is turned down toward the nose to cover the area where cancer has been removed.

For three weeks, the flap grafts the nose wound. Then, the flap is separated completely from the forehead, and its top edge sewn to the top of the nose. Although the flap procedure is complicated, the one-day process enabled Ledbetter to arrive at the Outpatient Center in Redwood City at 8 a.m., Feb. 17, and head home at 4:45 p.m. Two months later, her healing is not considered complete, but she boasts that her friends “can’t tell I’ve had surgery.”

“Hearing that from a patient is my best reward,” Hollmig said.

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Mohs surgery for melanoma offered at Stanford Health Care