The rise of skin cancer is directly linked to exposure to the sun without protection. In fact, is already the type most common malignancy, affecting in some countries like USA or Australia to one in three individuals. However, dermatologists have known how to react to this and in recent years have made great achievements in the daily fight against cancer. This is the case of a special type of dermatologic surgery: Mohs micrographic surgery, which gets a number of cures 99% of treated cases. Although very popular in the U.S. and has over 20 years practicing in Spain, is still done here in a minority.
This technique is indicated in various skin tumors, including basal cell carcinoma highly aggressive malignant tumor that metastasizes locally but other areas of the body. The risk of suffering throughout life varies between 11% and 18% depending on sex and place of residence and their main risk factor is again the sun’s ultraviolet radiation. Hence it appears mainly in the head and neck. Precisely, “the location of high risk, as the face, is one of the indications for Mohs surgery, with tumors larger than two centimeters in size, recurrence and cancer by other means already with a strong tendency to reproduced, mainly, “says Pedro Jaén, Chief of Dermatology, Hospital Ramón y Cajal in Madrid.
This center is the first public health in Madrid that performs this technique, very popular, on the other hand, in American health, where 30% of all skin cancers are treated with this surgery and by which he has undergone several its former presidents, including Ronald Reagan, Bill Clinton and George Bush. And is that the results of this technique exceed those of any other. The cure rate in previously untreated basal cell carcinomas is 98-99%, whereas with traditional methods is achieved in 90-96% of cases. And if playing the tumor, micrographic surgery is even more useful, cures 86-92%, for 50% of other techniques. Another advantage, says Paul Umbert, Sacred Heart University Hospital (Barcelona) and that this surgery practice since 1981, is that “in 95% of cases the procedure is outpatient with local anesthesia.”
Julián Sánchez Conejo-Mir, Professor of Dermatology, Hospital Virgen del Rocío (Sevilla) and president of the European Society of Micrographic Surgery, explains that this is a “technical and pretty laborious to perform, since it involves removing the tumor in layers . The tumor is processed fresh, with the help of a cryostat. Chop and numbered the pieces to produce a map that maintains the correct orientation of the area removed. Once stained the pieces are analyzed under a microscope, which are located the potential areas with malignant cells. If there are still remnants of the tumor, the whole process is repeated until the previous surgical site is clean. Once tumor-free, dermatologist close the defect made by flaps or grafts. In a single act, has removed the tumor with a high reliability and the defect has been reconstructed.
“Although it may exceed two hours of intervention,” Sanchez continues, “This is a technique that saves money in the public health system, since it avoids reoperation and patient, blind excisions deformities in facial aesthetic areas”. Ideally, explains Juan Ramón Garcés, Dermatology Service, Hospital de Sant Pau (Barcelona), is that any assistance can be made “removal, reading and reconstruction, although in some cases not possible and the last subsequent step is performed. ”
This technique combines dermatology, surgery and histology, as highly specialized demands of the dermatologists or work with pathologists to the correct reading of the tumor, as is the case of Ramón y Cajal. This fact, together can consume many hours of surgery to the total elimination of the tumor are the two main reasons for its poor implementation in public health. In fact, where more is done is in Barcelona, Valencia (Valencian Institute of Oncology), Seville, Madrid and Guadalajara and the centers receive patients from all over Spain. However, thanks to the good health of dermatology in Spain from the Spanish Group for Dermatologic Surgery, Laser and Cutaneous Oncology is hoped that in 10 years this technique is performed on all first-rate Spanish hospitals.
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