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January 11, 2023

Jill Biden undergoes Mohs surgery to remove a skin lesion; here's what it entails

The procedure gradually cuts away layers of skin so they can be examined for cancer. The process continues until there are no signs of cancer

First lady Jill Biden traveled to a military hospital Wednesday to remove a lesion found above her right eye during a routine skin examination.

Doctors recommended she undergo Mohs surgery to remove the lesion, citing "an abundance of caution," according to a White House memo written by Dr. Kevin O'Connor, the physician to President Joe Biden. The lesion will be examined afterward to determine whether it is cancerous.

Mohs surgery has become a common treatment for removing basal and squamous cell carcinomas, two of the most common types of skin cancer. About 5.4 million basal and squamous cell skin cancers are diagnosed each year in the U.S. Squamous cell carcinomas grow more quickly than basal cell carcinomas, but both are very treatable when detected early enough.

The procedure, developed by surgeon Frederic Mohs in the 1930s, involves removing a visible layer of skin tissue so it can be analyzed in a lab for signs of cancer. The surgeon first marks the site for the biopsy and then numbs the area with anesthesia. The patient stays awake during the surgery.

After the tissue is removed, the surgeon marks areas of the skin sample with colored dyes and creates a map of the surgical area using a freehand drawing or a complication. After the sample is frozen, lab technicians cut the tissue into sections and study it under microscope. When cancerous cells are detected along the margins of the sample, the surgeon uses the map to identify how much additional tissue may need to be removed.

More layers of skin are then removed until the tissue is cancer-free. This technique spares the maximum amount of healthy surrounding tissue.

Mohs surgery also can be used to treat melanoma and other less-common skin cancers, according to the Mayo Clinic. It is most effective for cancers that have a high recurrence rate and in areas where people want to keep as much healthy tissue as possible. This includes areas around the eyes, ears, nose, mouth, hands, feet and genitals.

It has a success rate of up to 99% because it more closely evaluates the surrounding tissue than traditional skin cancer surgery techniques, according to Johns Hopkins Medicine. It has become the gold standard for treating high-risk skin cancers, including those located on the head and neck or considered highly aggressive. 

Surgery risks include bleeding, pain at the surgical site and infection. In rare cases, patients can suffer temporary or permanent numbness, or weakness, at the surgical site if nerve endings or nerve muscles are cut. In situations when the cancer is extensive, reconstructive surgery may be needed.

Cancer prevention and treatment has been one of Jill Biden's signature priorities as first lady. She lost her son Beau to brain cancer in 2015. She frequently visits cancer research and treatment centers to promote their work and to encourage people to get screened. Her husband's Cancer Moonshot Initiative aims to cut the cancer death rate by at least 50% within the next 25 years.

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