Skin cancer is one of the most common cancers, with 1 in 5 Americans developing it by the time they’re 70-years-old. Thankfully, skin cancer is also one of the most treatable (and preventable), provided it’s detected early and cared for properly.
Even with all the right preventions in place, skin cancer can still pop up unexpectedly. If you’re going to your regular skin screenings, the cancer is likely to be caught by your doctor. From there, Mohs surgery is the best option for removing your skin cancer so you can return to living your life in peace.
Dr. Alison Durham was raised in Burton, Ohio where she graduated from Berkshire High School. She then went on to attend Ohio Wesleyan University, where she graduated with a degree in Biochemistry and received accolades for mathematics and chemistry. After undergraduate school, she moved to San Diego and worked as a research assistant at the Scripps Research Institute in the lab of Dr. Paul Schimmel before attending medical school.
Dr. Durham received her Doctor of Medicine (M.D.) degree at the University of Michigan Medical School in 2008, where she earned an Academic Recognition Award, presented to the top five graduates each year. Following graduation, she completed her transitional year internship at Summa Health System in Ohio, and her dermatology residency at the University of Michigan, where she served as Chief Resident in her final year. She completed an ACGME-accredited Procedural Dermatology Fellowship at the University of Michigan, prior to her recruitment as a clinical lecturer in dermatology in 2013. Dr. Durham became a Clinical Assistant Professor in 2014 and was promoted to Clinical Associate Professor in 2020.
What is Mohs?
Mohs surgery is a tissue sparing technique used to treat skin cancers that was developed by Dr. Frederick Mohs in the 1930s.
“Once skin cancer is diagnosed, it can be treated with Mohs surgery in an outpatient setting. The procedure involves numbing the biopsy site with local anesthesia, the surgeon takes a small layer of tissue around the biopsy site. The patient waits while the tissue is processed and evaluated by the surgeon. If the cancer has not been completely removed with the first layer, additional tissue is removed only in the area necessary.”
When the skin cancer has been completely removed, the surgeon and the patient discuss options for healing, which can include stitching the area or letting it heal on its own.
Because Mohs surgery involves taking small layers and checking as we go, it is associated with the highest cure rate and has the advantage of leaving the smallest possible scar.
Why are some skin cancers removed with Mohs and others not?
“Mohs surgery is generally the preferred treatment option for skin cancers in specific locations where sparing as much normal tissue as possible is important – such as the head and neck.”
Additionally, Mohs surgery is also preferred for certain types of skin cancer that may have a microscopic extension of cancer into nearby normal tissue, or for skin cancers that have recurred after being treated with another method.
What should you look for in a Mohs provider?
“When choosing a Mohs surgeon, patients should look for someone that has undergone fellowship training and choose an office that allows for easy access to appointments so that the cancer can be treated as soon as possible after biopsy.”
Mohs surgery is a specialized technique that requires additional training after Dermatology residency, called a fellowship.
During the fellowship year, the surgeon learns the skills necessary to accurately interpret microscopic slides. In addition, the surgeon learns reconstruction techniques so that wounds can be repaired to maintain function and minimize scarring.
The Mohs surgeons at Apex are all fellowship trained and highly experienced. Dr. Garcia-Zuazaga earned his fellowship from Harvard Medical School, Dr. Killian from The Skin Cancer Center, and Dr. Durham from The University of Michigan. Combined they have successfully treated over 70,000 skin cancers.
How did you get into the field of Mohs surgery?
In college, I studied Biochemistry with a plan to pursue a career in basic science research, and after graduating from college I worked in a lab for two years. While I enjoyed my time in the lab, ultimately I decided that I wanted a career that would allow me to work directly with people and I decided to go to medical school.
I was drawn to Dermatology as a field because of the variety of the specialty and because skin diseases and skin cancers have an enormous impact on quality of life. I decided to pursue a fellowship in Mohs surgery so that I could focus my practice on optimizing the treatment of skin cancer for my patients.
What is the most rewarding part of your job?
I really enjoy that Mohs surgery allows me to spend a little more time with my patients during their visit, which lets us have time to talk a bit and get to know each other.
It is great to be able to ensure that their cancer is gone before they leave and to work together to find a plan for healing that leaves them with a minimal scar after their surgery.
How does your Mohs team assist?
Our team understands that having skin cancer surgery can be stressful, so we work together to ensure that patients have the best experience possible. Our medical assistants help get patients ready for the procedure by making sure the patient is comfortable, numbing the area, and assisting during both the removal and repair parts of the procedure. Our histo-technician prepares the slides for the surgeon to read, this step is really the true difference with the Mohs technique because slides are made so all of the tissue edges can be evaluated.
Our team’s focus is always on the patient and ensuring their skin cancer can be treated in the most comfortable and efficient manner possible, with the highest cure rate and best cosmetic result.
What’s the best advice you give to patients, friends and family about skin cancer?
“The majority of skin cancer is related to sun exposure over your lifetime. While you don’t need to be afraid of the sun, it is important to protect yourself from sunburns and suntans by wearing sunscreen and sun-protective clothing.”
It is beneficial to set up routine skin exams with your dermatologist to screen for skin cancer so that cancers can be identified as early as possible. Often skin cancers can be subtle and hard to notice, but if you have a spot on your skin that is changing in some way (size, shape, or color) or a spot that is not healing you should call to set up an appointment to have it checked.
Do you have your regular skin checks scheduled? For any suspicious skin growths, make sure to schedule an appointment to get your skin checked today!