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Dr. Firoz discusses skin cancer prevention with her patient as she prepares her for Mohs surgery.

Saving face

March 2011

by Shelia Hotchkin

After a routine dermatologist visit found several suspicious lesions on his face and head, Phil Holcomb had a decision to make.

He could have opted for standard surgical excision, which takes cancerous cells along with a surrounding margin of healthy skin to ensure the cancer is gone. This can cause scarring, which many patients find particularly unwelcome on their faces.

But Sandra Osswald, M.D., Holcomb’s dermatologist and chief of the UT Health Science Center’s Division of Dermatology and Cutaneous Surgery, offered an alternative: Mohs micrographic surgery, a precise technique that can remove skin cancers while causing as little damage as possible to healthy tissue.
essica Frias, a Mohs histology technician
Jessica Frias, a Mohs histology technician, prepares a slide for evaluation by UT Medicine San Antonio dermatologists.
Photo by Rocelyn Aala Dunston
Holcomb had four basal cell carcinomas removed using Mohs surgery and was pleased with the results. "Mohs is a very delicate surgery. It’s designed to leave minimal scarring, if any at all," he said.

The UT Health Science Center is home to one of just a handful of fellowship-trained Mohs surgeons in San Antonio. Bahar Firoz, M.D., M.P.H., director of Mohs and laser surgery, gained advanced knowledge of the procedure during a year-long postdoctoral fellowship and is a member of the American College of Mohs Surgery.

At the new dermatology clinic, Dr. Firoz - who performed Holcomb’s surgeries - has a comfortable space for her Mohs patients, along with an adjoining laboratory for analyzing tissue and a dedicated staff that includes a histologist, a nurse and a medical assistant.

Before her fellowship, Dr. Firoz saw many patients with noticeable facial scarring from earlier excisions that had taken large margins of healthy skin. She was drawn to Mohs surgery by "the beauty of knowing a tumor was completely gone while being trained to reconstruct an area well."

At first glance, lesions, like the ones pictured above, may not appear life-threatening. But after assessment by a UT Medicine San Antonio dermatologist, each of these lesions proved cancerous.
Dr. Firoz, who also performs standard surgical excisions, does not use Mohs surgery in every case, and in some instances it is not covered by insurance. But it typically is covered and particularly useful in certain situations - among them, skin cancers of the head, neck, hands and feet; large tumors; and in patients with weakened immune systems.

Besides the obvious cosmetic benefits of excising less skin, Mohs has the highest five-year cure rate for skin cancers: 99 percent for previously untreated basal cell cancers, compared with 95 percent for standard surgical excision. For recurrent skin cancer, Mohs cure rate is especially good: 93 percent, compared with 80 percent for standard surgical excision.

During the outpatient procedure, Dr. Firoz removes visible cancer along with a very small margin - perhaps 1 millimeter - of healthy skin. While the patient waits, the tissue is examined under a microscope. The analysis takes about an hour; if it finds evidence of remaining cancer, Dr. Firoz removes a little more tissue until the cancer is gone.

Dr. Firoz encourages Mohs patients to bring a book, snacks or whatever else they need in case they’re at the clinic for an extended period of time, but she usually has patients out by lunchtime.

That was the case for Holcomb. "It’s not a bad experience. Nobody likes to have surgery, but they make it as agreeable as possible."

To make an appointment with a UT Medicine dermatologist, call 210-450-9840 or visit UTMedicine.org.

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