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Upstate offers new skin cancer treatment

SYRACUSE, N.Y. — Upstate Medical University is offering Mohs Micrographic Surgery, an advanced skin cancer treatment that gives the highest possible cure rate for many skin cancers while minimizing damage to normal tissue. The surgery is primarily used to remove the two most common forms of skin cancer, basal and squamous cell carcinomas, but can be used to treat less common tumors including melanoma.

"Current estimates are that one in five Americans will develop skin cancer in their lifetime," said Michael C. Iannuzzi, M.D., M.B.A., professor and chair of Upstate's Department of Medicine. "The Upstate Medical University Mohs Surgery Center is a much needed medical resource for the citizens of Central New York."

Ramsay-S. Farah, M.D., and his sister Joyce B. Farah, M.D., offer this procedure through Upstate's Department of Medicine. Ramsay-S. Farah is an associate professor of medicine and pathology and chief of the dermatology division of the Department of Medicine and has boards in dermatopathology. Joyce Farah is an assistant professor of medicine with fellowship training in photodynamic therapy, a non-surgical treatment for pre-cancers and non-melanoma skin cancers.

Mohs surgery is usually performed as an outpatient procedure. Local anesthesia is administered around the area of the tumor allowing the patient to remain awake throughout the procedure. "The cure rates for Mohs Micrographic Surgery approach 99 percent for most previously untreated cancers with a slightly lower cure rate for secondary or recurrent cancers," said Ramsay-S Farah.

Mohs surgery preserves the greatest amount of normal tissue, providing the foundation for the best reconstructions and limiting scarring or permanent disfigurement, according to Farah.

In Mohs surgery, the visible portion of the tumor is surgically removed. A layer of the skin is removed and divided into sections that are color-coded with dyes. The surgeon makes reference marks on the skin to show the source of these sections and then draws a map of the surgical site. The tissues are examined while the patient remains in the waiting room. The undersurface and edges of each section are then microscopically examined for evidence of remaining cancer. This method of processing the tissue allows for examination of 100 percent of the surgical margins and accounts for the high cure rate seen with this procedure. If the cancer cells are found, their locations are marked onto the map by the surgeon who will then remove another layer of skin precisely from the site that the cancer cells remain. The removal process stops when there is no longer any evidence of cancer remaining in the surgical site.

Mohs surgery is appropriate when the cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, fingers, toes and genitals. It is also appropriate if the cancer was treated previously and has recurred, or if the cancer is large, if the cancer is growing rapidly or uncontrollably, or the edges of the cancer are not clearly defined.

Prospective patients must have a biopsy-proven skin cancer and meet the criteria for Mohs surgery indications. The procedure is covered by most insurance plans.

In addition to Mohs surgery, Joyce Farah will spearhead a Photodynamic Therapy Unit in the Mohs surgery suite. PDT is a non- surgical treatment for pre-cancers and certain non-melanoma skin cancers. During the treatment a photosensitizing agent is painted on the patient's skin and it preferentially concentrates in sun-damaged cells. After an incubation of one to two hours, the medication is activated by a special light source. Once activated, the medication destroys the sun-damaged cells.

Photodynamic therapy is appropriate for individuals who have significant sun damage, numerous actinic keratoses and some superficial forms of basal cell and squamous cell carcinomas. It is particularly useful for transplant patients who have weakened immune systems from their transplant medications.