Future Applications of Mohs Surgery
Mohs surgery can be applied to any relatively non-aggressive locally invasive tumor with a contiguous growth pattern (i.e. no skipped growth, or metastasis). Today, most Mohs procedures are performed by dermatologists. However, pathologists, plastic surgeons, and otolaryngologists have been trained and are utilizing Mohs surgery in their practice as well. Hopefully, as more physicians are trained in the method, Mohs surgery can be applied to other organs systems beside the skin. The limitation of this application to other tumors (i.e. prostate cancer, cervical cancer, laryngeal cancer) is that the tumor must be in the earliest stages and no metastasis has occurred. The second problem with Mohs surgery is the prolonged procedural time, which might require prolonged general anesthesia.
Currently, the American College of Mohs Surgery has limited training to physicians who have done a dermatology residency. The American Society for Mohs Surgery continues to encourage the training of physicians of all specialties to learn and apply the method invented by Dr. Frederick Mohs. The argument against physicians of other specialties than dermatology gaining Mohs training is that they are not adequately trained in dermatopathology. The argument for training other physicians beside dermatologists is that most Mohs surgeons do not make the initial diagnosis of the skin cancer – thus misdiagnosis can be avoided. The pathology of Mohs sections are then limited to a few easily identifiable cancers; and the pathology of normal skin is simple enough to gain in a short preceptorship.
Dr. Mohs, a general surgeon, encouraged physicians of all surgical specialties to learn and apply his technique to the treatment of skin cancer; it is understood that he never intended to limit his method to be utilized by dermatologists alone. In countries where dermatology is not well developed, the Mohs procedure can easily be learned by any surgeon or pathologist after a short preceptorship – the same way Dr. Mohs taught many current Mohs surgeons.
Quotation from Dr. Mohs first book:"The book should be useful to physicians who may be called on to treat or advise regarding treatment of skin cancers and other conditions that are described. This includes dermatologists, surgeons, plastic surgeons, otolaryngologists, gynecologists, urologists, proctologists, pathologists, internists, and general practitioners."
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