MARCO Grand Rounds for December 14, 2008

From Warren, KD4GUA:

This Sunday we are going to discuss "MOHS SURGERY."

To those not familiar with Mohs a brief description....you find a growth on your nose and go to a dermatologist. He says "We can remove it by standard means and it will cost you $100 or we can use Mohs surgery and it will cost you $3,000.

Which would you pick? Why would anyone go for the more expensive way? Are surgeons using this to pad their wallets or are they honest in the their recommendation? This is your problem as a doctor and a patient--what choice should I make?

Tune in, should be interesting.


There has been some interesting email in follow-up to this topic.

Alfred Greenwald WA2CBA, a retired plastic surgeon described his experience:

Just to add a note on my experience with MOHS Surgery in the discussion on Sunday. As a plastic surgeon, I was not impressed with MOHS technic because in the two cases I saw prior to my retirement, the dermatologist doing the original procedure was not able or capable of handling the reconstruction with restoration of function.

1) A dentist friend of mine who served with me in the Army in 1955 had MOHS surgery by a dermatologist for a basal cell carcinoma of the right lower eyelid resulting in an ectropian of the lid. I reconstructed the lower lid using a full thickness skin graft taken from the upper lid and suturing the upper and lower lid margins together temporarily for a week with an excellent end result.

2) An elderly male patient who consulted with me wearing a band aide across the upper lip. A local plastic surgeon had referred him to the same dermatologist from the case above who treated this patient using MOHS surgery to remove a basal cell carcinoma of the mid portion of the upper lip just beneath the columella of the nose. He had a wide defect of the upper lip showing his upper central incisor teeth with his lateral lips closed. I recommended reconstruction of the upper lip using a two stage procedure with a V shaped pedicle flap from the lower lip. He declined the surgery and continued to wear the band aide.

73s,

Alfred WA2CBA

Mary K Favaro AE4BX had these memories:

I have the honor of actually knowing and being taught by Dr. Mohs (thought I'd throw that in for some celebrity prestige....). He had already retired but was a professor emeritus when I was a med student at Univ of Wisconsin. He came in for some dermatology lectures - on - you guessed it his Mohs technique. This was in the mid 60's and derms were still being trained in the procedure.

Also had Dr. Schilling of the Schilling test as a hematology prof. And of course WARFarin is named for the Wisconsin Alumni Research Foundation" after their work on cows and fermented grain.

I myself haven't invented anything important enough to carry my name. Maybe that's why I'm banished to the South.

Still traveling and doing Locum Tenens. Hope to get some station time when the sunspots improve enough to make my lousy attic antennas function.

Mary K Favaro MD
Surfside Beach SC