The number of patients who have been cured demonstrates that Mohs surgery is the most successful of all methods for the treatment of skin cancer. Utilizing the Mohs technique, the cure rate is usually 95% - 99%, even if other forms of treatment have failed.

Mohs Surgery is a term from the originator of the surgical procedure. Dr. Frederic Mohs, professor of Surgery at the University of Wisconsin, developed this specialized technique for the treatment of skin cancers. It is a method of surgical excision in which the microscope is used to determine the precise location and extent of the tumor. Microscopic control enables the surgeon to trace the cancer to its roots, at the same time sacrificing the least amount of normal healthy tissue. For this reason, skin cancers in difficult locations such as  those involving the ears, eyelids, nose or lips are ideally treated with the Mohs technique. Also, cancers that are hidden in scar tissue from previous procedures can be effectively treated this way.

The surgical procedure itself involves several steps. First, the skin suspicious for cancer cells is numbed with a local anesthetic. A thin layer of tissue is then surgically removed and carefully divided into small sections. It is marked with colored dyes to distinguish left and right, tip and bottom. The excised pieces of tissue are then examined under the microscope at the time of surgery. In this way, the location of any remaining tumor can be pinpointed precisely. If more cancer cells are found, this process is repeated, but only in the area of the remaining cancer. The procedure is usually done entirely in our office. Several thin layers of tissue may need to be removed, but all surgery is generally completed in one day.

Mohs surgery requires highly advanced training and technology; therefore, few medical centers and private offices in the United States are equipped to offer such treatment.

At New York University Medical Center, New York, NY, after training in Dermatology, Dr. Valente received additional training in Mohs micrographic surgery with renowned expert Dr. Perry Robins. Dr. Valente is Board Certified by the American Board of Mohs Micrographic Surgery and Cutaneous Oncology.

Dr. Valente has since successfully performed nearly 15,000 Mohs treatments.

Dr. Valente's offices makes the specialized technique of Mohs surgery available in Manhattan and Long Island. Dermatology, Laser & Plastic Surgery and The NY Aesthetic Center have seven operation suites which are accredited by A.A.A.H.C., a laser facility and a frozen section laboratory operated by two licensed histology technicians on the premises.

Additional information about Mohs Surgery

Skin Cancers

Melanoma

Melanoma is the most serious form of skin cancer. However, if diagnosed and removed while it is still thin and limited to the outermost skin layer, it is almost 100% curable. Once the cancer advances and metastasizes (spreads) to other parts of the body, it is hard to treat and can be deadly.

Melanomas fall into four basic categories. Three of them begin in situ and sometimes become invasive; the fourth is invasive from the start.

1. Superficial Spreading Melanoma - the most common type, accounting for about 70 percent of all cases. This melanoma travels along the top layer of the skin for a fairly long time before penetrating more deeply.
   The first sign is the appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat geometrical in form. The color varies, and you may see areas of tan, brown, black, red, blue, or white. Sometimes an older mole will change in these ways, or a new one will arise. The melanoma can be seen almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women, and the upper back in both. Most melanomas found in young people are of the superficial spreading type.
2. Lentigo Maligna Melanoma - Similar to the superficial spreading type, it also remains close to the skin surface for quite a while, and usually appears as a flat or mildly elevated mottled tan, brown, or dark brown discoloration. This type of in situ melanoma is found most often in the elderly, arising on chronically sun-exposed, damaged skin on the face, ears, arms, and upper trunk. Lentigo maligna melanoma is the invasive form.
3. Acral Lentiginous Melanoma - Spreads superficially before penetrating more deeply. It is quite different from the others, though, as it usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. This type of melanoma is sometimes found in dark-skinned people.
   It is the most common melanoma in African-Americans and Asians, and the least common among Caucasians.
4. Nodular Melanoma - Unlike the other three types, Nodular Melanoma is usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. The color is most often black, but occasionally is blue, gray, white, brown, tan, red, or skin tone.

Additional information about Melanoma

Basal Cell Carcinoma

Basal cell carcinoma is the most common form of skin cancer, affecting 800,000 Americans each year. In fact, it is the most common of all cancers. One out of every three new cancers is a skin cancer, and the vast majority are basal cell carcinomas, often referred to by the abbreviation, BCC. These cancers arise in the basal cells, which are at the bottom of the epidermis (outer skin layer). Chronic exposure to sunlight is the cause of almost all basal cell carcinomas, which occur most frequently on exposed parts of the body -- the face, ears, neck, scalp, shoulders, and back. Rarely, however, tumors develop on non-exposed areas.

Signs to watch for:
• Open Sore that bleeds, oozes, or crusts and remains open for three or more weeks. A persistent, non-healing sore is a very common sign of an early basal cell carcinoma.
• Reddish Patch or irritated area, frequently occurring on the chest, shoulders, arms, or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.
• Shiny Bump or nodule, that is pearly or translucent and is often pink, red, or white. The bump can also be tan, black, or brown, especially in dark-haired people, and can be confused with a mole.
• Pink Growth with a slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.
• Scar-like Area which is white, yellow or waxy, and often has poorly defined borders. The skin itself appears shiny and taut. Although a less frequent sign, it can indicate the presence of an aggressive tumor.

Additional information about basal cell carcinoma

Squamous Cell

Squamous cell carcinoma is the second most common skin cancer after basal cell carcinoma, afflicting more than 200,000 Americans each year. It arises from the epidermis and resembles the squamous cells that comprise most of the upper layers of skin. Squamous cell cancers may occur on all areas of the body including the mucous membranes, but are most common in areas exposed to the sun.

Although squamous cell carcinomas usually remain confined to the epidermis for some time, they eventually penetrate the underlying tissues if not treated. In a small percentage of cases, they spread (metastasize) to distant tissues and organs. When this happens, they can be fatal. Squamous cell carcinomas that metastasize most often arise on sites of chronic inflammatory skin conditions or on the mucous membranes or lips.

Additional information about squamous cell carcinoma

Actinic Keratosis (AK)

An actinic keratosis (AK), also known as a solar keratosis, is a scaly or crusty bump that arises on the skin surface. The base may be light or dark, tan, pink, red, or a combination of these. . . or the same color as your skin. The scale or crust is horny, dry, and rough, and is often recognized by touch rather than sight. Occasionally it itches or produces a pricking or tender sensation. It can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can even bleed.

The skin abnormality or lesion develops slowly and generally reaches a size from an eighth to a quarter of an inch. Early on, it may disappear only to reappear later. You will often see several AKs at a time. An AK is most likely to appear on the face, ears, scalp, neck, backs of the hands and forearms, shoulders, and lips - the parts of the body most often exposed to sunshine. The growths may be flat and pink or raised and rough.

AK can be the first step in the development of skin cancer. It is thus a precursor of cancer or a precancer.

Additional information about actinic keratosis

Preventative Measures for Skin Cancer

1. Perform a full body skin examination using a full-length mirror a minimum of every six weeks. Any changing moles or blemishes may indicate a suspicious or malignant condition and should be examined by a health care professional as soon as possible. An annual full-body screening is also recommended for proper health maintenance. Early detection can make all the difference.
   Check:
   Asymmetry - One half is different from the other.
   Border - Irregular, scalloped or poorly defined border
   Color - Varied from one area to another
   Diameter - Generally, no larger than 6 mm
2. Protective clothing (i.e., hats) will help prevent dangerous sun exposure. Keep in mind that sun exposure can occur in a variety of weather conditions, including overcast or snowy days, and that you are at risk for sun exposure when you are in water.
3. Proper application of a sunscreen with a minimum Sun Protection Factor (SPF) of 15 that includes UVA and UVB protection from harmful sun rays. Sunscreen should be applied at least one-half hour before sun exposure, and reapplied appropriately after individual swims. Remember, overexposure to the sun could lead to skin cancer.
   It's important to note that indoor tanning is not a safe alternative to outdoor sun exposure.