Skin Cancer Center
Skin Cancer is by far the most common malignant tumor in humans. More than 1.2 million Americans are diagnosed with skin cancer each year. The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. Both basal cell carcinoma and squamous cell carcinoma begin as a single point in the upper layers of the skin and slowly enlarge, spreading both along the surface and downward. These extensions or “roots” of the tumor cannot be directly seen. The tumor roots often extend far beyond what is visible on the surface of the skin. So what is seen by the naked eye is the “tip of the iceberg” and much of the tumor may be under the skin. If not completely removed, skin cancer will continue to grow and invade and destroy structures in their path. Metastasis (distant spread) of basal cell carcinoma is extremely rare and usually occurs only in the setting of long-standing large tumors where the patient’s immune system is compromised. Squamous cell carcinoma is more dangerous, and patients must be observed for any spread of the tumor. Such spread is still infrequent. Excessive exposure to sunlight (beginning in childhood) is the single most important factor associated with the development of skin cancers. In addition, the tendency to develop these cancers appears to be hereditary in certain ethnic groups, especially those with fair complexions and poor tanning abilities. Fair-skinned people develop skin cancers more frequently than dark-skinned people, and the more sun exposure they receive, the more likely they are to develop a skin cancer. Other factors, including exposure to radiation, trauma, and exposure to certain chemicals, may also be involved in the development of skin cancers. The vast majority of skin cancers are present for more than a year before being diagnosed and their growth is rather slow. Skin cancers may be more aggressive in certain instances: patients whose immune system is compromised, patients with a medical history of leukemia or lymphoma, cancers in certain locations such as the ear, lips, lower nose or around the eyes.
Mohs Micrographic Surgery
Mohs micrographic surgery is a state-of-the-art treatment for skin cancers where the Mohs surgeon acts as surgeon, pathologist and reconstructive surgeon. It is named after the surgeon, Dr. Frederick Mohs, who pioneered this precise technique. Mohs surgery relies on the precision and accuracy of a microscope to identify and map out the roots of the skin cancer to give the highest chance that the entire tumor will be removed (exceeding 97%). There are other methods to treat skin cancer like cryosurgery (freezing), electrosurgery (burning), standard surgery, radiation and laser. But these methods do not have as high a cure rate as Mohs surgery. No surgeon or technique, however, can guarantee 100% cure. Mohs micrographic surgery allows for the selective removal of the skin cancer with the preservation of as much of the surrounding normal tissue as possible. As a result, Mohs micrographic surgery is very useful for larger tumors, tumors with a more infiltrated or “finger-like” growth pattern, tumors with indistinct borders, tumors near vital functional or cosmetic structures, tumors that have been previously treated and tumors located in areas with a higher chance to recur like the nose or areas around the nose, the ear, the eyes or areas around the eyes, the lips or areas around the lips and the temple areas.
Once the obvious tumor is removed, there are two basic steps to each Mohs micrographic surgery stage. First, the tumor and a thin 1-2 mm layer of tissue surrounding the tumor is surgically and precisely excised around and below the area of the cancer. This layer of tissue is mapped out and oriented so that the exact location of the tumor is known in relation to the area of the surgical site. Next, this layer of tissue is processed in a unique manner and examined under the microscope. On the microscope slides, Dr. O’Donnell examines the entire bottom surface and outside edges of the tissue. (This differs from the “frozen sections” prepared in a hospital setting which, in fact, represent only a tiny sampling of the tumor margins.) If any tumor roots are seen during the microscopic examination, the exact location is determined via the precise map and a thin layer of additional tissue is excised only at the precise location of the tumor root. The entire process is repeated until no tumor is found. Thus, Mohs micrographic surgery maximizes the chances that all the tumor and only the tumor is removed, thereby minimizing the removal of normal tissue.
Michael J. O’Donnell, M.D., graduated from Thomas Jefferson Medical School in Philadelphia. Following five years in the United States Navy serving as a Naval Flight Surgeon, he completed a three-year Dermatology residency at the University of Iowa Hospitals and Clinics. Dr. O’Donnell is Board Certified in Dermatology. He then completed an additional two-year Fellowship training in Dermatologic Surgery and Oncology and Mohs Micrographic Surgery at the University of Iowa Hospitals and Clinics and is a Fellow of the American College of Mohs Micrographic Surgery and Cutaneous Oncology.
Gina Kuloszewski, PA-C is the Mohs surgical physician’s assistant. Gina received her Bachelors of Science and physician’s assistant at King’s College. She is a member of the Society of Dermatology Physician’s Assistant and American Academy of Physician’s Assistant.
Jean Kilcullen, R.N., is the Mohs surgery nurse. Jean received her Associates Degree in Nursing at Marymount College of Virginia. She also received her Bachelor of Arts Degree in Psychology and her Elementary Education Certification from Rosemont College. She is a member of the Dermatology Nurses’ Association and the Association of Perioperative Registered Nurses.
Gina Ackley, HT(ASCP), is the Mohs laboratory histotechnician. Gina received her histology training at the Geisinger Medical Center and is a member of the American Society of Mohs Histotechnology. Gina is board registered with the American Society of Clinical Pathologists.
Dawn Henehan, RMA, is the Mohs medical assistant. Dawn received her certification at Ultrasound Diagnostic Schools in Iselin, New Jersey, and is registered with the American Medical Technologists. Dawn is a member of the American Society of Mohs Histotechnology.
Anne Kish is the Mohs Nursing Assistant. Anne received her diplomas as a Nursing Assistant and Medical Assistant from the Stratford Career Institute.
Megan Woodyshek, S.T., is a Mohs surgical technologist. She received her associates degree from McCann School of Business and Technology.