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Mohs Surgery Removes Skin Cancer, Preserves Tissue

Carl Waldschmidt Skin cancer survivor Carl Waldschmidt stays active by taking his Old English sheepdog, Elvis, for walks along Chicago's lakefront.

Eighty-two-year-old Carl Waldschmidt of Chicago knew the raised pink sore on his lower lip that wouldn’t heal could be skin cancer. Thirty years ago, he supported his mother as she battled basal cell carcinoma on her face.

"She blamed the cancer on being overexposed to the sun as a young girl in Germany," said Waldschmidt, whose mother, Frieda, worked on her family’s farm. "As for me, I am fair-skinned and I burnt myself to a cinder during the days of my misspent youth.”

Back in the early 1980s, Waldschmidt gave his mother pep talks when she felt discouraged by frequent cancer treatments, telling her she needed to continue "nipping it in the bud." When a particularly aggressive skin cancer on his mother’s forehead was successfully treated with Mohs micrographic surgery, he says he was amazed at how well it went.

Waldschmidt's skin cancer was removed in three stages in just over three hours.

Mohs micrographic surgery involves the staged removal of thin layers of skin tissue affected by cancer. Each layer is microscopically examined for evidence of remaining cancer. The physician removes additional layers until no cancer cells remain. Because it is minimally invasive and highly precise, healthy tissue surrounding the tumor is preserved, scarring is reduced and the surgical site heals quickly.

Developed in 1936 by surgeon Dr. Frederic Mohs, the intricate procedure has been refined many times over the years due to advances in instrumentation and technical improvements. Today, it is the most effective therapy for common non-melanoma skin cancers, offering the best possible cosmetic result and the highest cure rate for many basal cell and squamous cell carcinomas.

"Remembering my mother’s excellent outcome from Mohs surgery, I asked my gastroenterologist, Dr. B. H. Gerald Rogers, for a referral to a Mohs expert," Waldschmidt said. "He sent me to his colleagues at the University of Chicago."

Dermatologist Keyoumars Soltani, MD, director of the skin surgery clinic at the University of Chicago Medicine, biopsied the tumor and diagnosed basal cell carcinoma. He referred Waldschmidt to his colleague, Diana Bolotin, MD, PhD, a fellowship-trained Mohs surgeon skilled in dermatologic surgery, pathology and reconstruction.

Diana Bolotin, MD, PhD in the Mohs micrographic surgery laboratory
Diana Bolotin, MD, PhD, in the Mohs laboratory in the Center for Advanced Medicine.

"Although Mr. Waldschmidt’s cancer was clinically visible only at the border of his lower lip, it had ‘roots’ that went up into his lip and down into his chin," explained Bolotin. "His type of basal cell carcinoma tends to be insidious and locally destructive. It needed to be removed before it spread further."

Waldschmidt was sure the results from Mohs would be good, but felt even more confident after meeting Bolotin. "She was very impressive. I liked her immediately and everyone on her team was extremely pleasant," he said.

Waldschmidt was sure the results from Mohs would be good, but felt even more confident after meeting Bolotin.

In November 2011, Bolotin performed the outpatient surgery in the special procedure suites of the University of Chicago Medicine dermatology clinic. After taking out each fine layer of skin tissue, Bolotin examined the tissue under a microscope and mapped areas that needed further treatment. She removed all of the cancer in three stages in just over three hours.

Between stages, Waldschmidt rested in the dedicated Mohs waiting room where he was encouraged to relax and eat. "I thought the day would feel like an ordeal, but instead it was pleasant and I found interesting people to talk to," he said.

At the end of the procedure, Bolotin repaired the surgical site with a flap fashioned from skin nearby the wound. Because of its elasticity, skin in that area can easily be manipulated and moved. Suture lines eventually blend in with the natural creases of the chin.

Waldschmidt had few restrictions on his activity following surgery and was able to take his Old English sheepdog, Elvis, for walks right away. "We go out four times a day, heading west in the morning and east toward the lake in the afternoon," he said. He wears a baseball cap and sunglasses for protection from the sun.

April 2012