When do you know they got "enough" during skin cancer surgery?

Pathology report: Depending on the type of skin cancer (melanomas require a larger margin) - the pathologist will use a microscope to look at the edges (margins) of the area removed.

Microscopic analysis: There are different ways to do it, but when you remove a skin cancer, the surgeon will send the removed skin to the pathologist to have them look at it to assess the tissue. If there is still cancer present on the edges (margins) of the removed skin, your surgeon will need to remove more skin to get all the cancer.

Mohs surgery: The gold standard is mohs micrographic surgery a process by which the tissue can be examined immediately under the microscope to check all margins to ensure that all the skin cancer is removed. Fellowship trained mohs surgeon can be found thru the american college of mohs surgery (acms): http://www.Mohscollege.Org/acms/.

MOHs: Mohs surgery or send to pathologist. Melanoma can't be done with mohs.

Skin cancer: There are different techniques to remove skin cancer. The technique that has the highest cure rate and that spares the most normal tissue is called mohs micrographic surgery. This method allows the cancer to be traced out under the microscope by examining the entire periphery of the excised tumor. If any roots are seen the excision and microscopic checking continues until tumor free plane obtained.

Pathology: The specimen removed is examined by the pathologist to determine clear margins. Different cancers require different minimal distances from the excised tumor to comfortably determine free and safe margins. This pathology exam can be checked after the specimen is removed and wound closed or at the same time as the excision.

Dermatologic surgeon: Can use a technique called moh's chemosurgery, a painstaking shaving and instant analysis of the "margins" to assure that they are clear. Used mostly with basal and squamous tumors, controversially and occasionally in melanoma. We used to compete in basal; they make the diagnosis. We get few referrals.

Margin Control: It depends on how the skin cancer is removed. With tradtional surgical excision an appropriate margin is added to the size of the lesion and the tissue removed is sent to a lab for the margin to be checked and ensure the cancer is all gone. With mohs microgrpahic surgery the specimen is checked while the patient remains in the office. It is sectioned horizontally as well (as opposed to vertically with a traditional excision) which allows nearly 100% of the peripheral and deep margins to be checked.

Frozen or permanent : Intra operatively there are methods used by. The dermatologist or pathologist to examine the wound edges of the resected specimen to determine if any cancer has been left behind. While generally accurate these frozen section techiques are not considered as accurate as permanent preparation analysis which may take a few days. Mohs technique is where surgeon acts as pathologist and surgeon.

Skin Cancer Treatment: It really depends upon the treatment chosen. For excisions (when the cancer is cut out), a margin of normal appearing skin is removed as well and the tissue is sent to the lab for evaluation under the microscope. For mohs' surgery, all of the margins are immediately evaluated under the microscope to ensure complete tumor removal. For curettage and desiccation, there is no evaluation performed by a lab.

Pathology report: After a skin cancer is excised or cut out of the skin, the specimen is sent to a dermatopathologist. It is analyzed under the microscope to make sure that the edges or margins are clear. This is how your physician knows that the cancer has been fully removed. In addition, for skin cancers on the face, mohs surgery can be done so each skin specimen is analyzed while you wait until margins are clear.