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12.04.2014

It is almost inconceivable how much the treatment of skin cancers has changed in the past 50 years. Today, a far greater variety of therapies exist, from topical medications and cryosurgery (freezing the tumors with liquid nitrogen) to lasers. In 1933, 23-year-old Frederic Edward Mohs was a research assistant assigned to inject different chemicals into cancerous rat tissues to produce specific reactions. When adequate fixation was achieved many hours later or by the next day,4 Mohs would remove the dressing and, using a scalpel, would surgically excise a saucer-shaped layer of the fixed tissue. Frozen sections were prepared of the undersides of each excised section, and they were mounted on slides and examined under the microscope. In 1965, the first chemosurgery unit was established at New York University Medical Center. Nonetheless, the potential value of the technique was all too clear to me, and I was convinced that with some additional training, dermatologists could become experts in excising skin cancers with the procedure.
In my first year using chemosurgery, I treated 70 patients, and each year that number increased slowly. In 1972, I began a study on the effectiveness of the new technique, comparing it with the fixed tissue technique.
The use of Mohs micrographic surgery to treat melanoma, still relatively new, continues to evolve. Tamil actor Dhanush, whose debut HIndi film Raanjhanaa released today, tweeted, 'I tried to do my best. After Aishwarya Rai, starlet Sofia Hayat turned up at the Royal Ascot horse race meeting in Berkshire, west of London. New York NYC Crime Bronx Brooklyn Manhattan Queens Education Weather Obituaries Sports Yankees Mets Giants Jets Knicks Nets Rangers Islanders Football Basketball Baseball Hockey Soccer College High School The Score More Sports News Crime U.S.
Follow Us Facebook Twitter Instagram Pinterest YouTube Subscribe Follow UsNewsletter App Subscriptions Subscribe Get Our Newsletter A daily blend of the most need-to-know Daily News stories, delivered right to your inbox. Select Sport Football Basketball Baseball Hockey Soccer College High School More Sports Crime U.S. POCATELLO, Idaho a€” Jenni Lake gave birth to a baby boy the month before her 18th birthday, though she was not destined to become just another teenage mother. While being admitted to the hospital, she pulled her nurse down to her at bed level and whispered into her ear. In photographs, the baby's ruddy cheeks and healthy weight offer a stark contrast to the frail girl who gave birth to him. It was only 12 days past the birth - half spent in the hospital and the other half at home - before Jenni was gone. Even so, her family and friends insist her legacy is not one centered in tragedy, but rather in sacrifice. This month, her family gathered at their ranch style home in Pocatello, where a Christmas tree in the living room was adorned with ornaments picked out just for Jenni, including one in bright lime green, her favorite color. The migraines started last year, when Jenni was a 16-year-old sophomore at Pocatello High School. She was sent to a hospital in Salt Lake City, some 150 miles south of Pocatello, and another scan there showed the mass was bigger than previously thought.
Her parents, who are divorced, remember they were brought into a room at the hospital and sat down at a long table as doctors discussed her chances of survival. In a picture taken at her prom in early May, Jenni is wearing a dark blue strapless dress and gives the camera a small smile. Her boyfriend, Nathan Wittman, wearing a black dress shirt and pants, is cradling her from behind. She had learned that she was pregnant, and an ultrasound would show the fetus was 10 weeks old.
From the start of treatment, she was told that she might never have children, her mother said, that the radiation and chemotherapy could essentially make her sterile.
Jenni didn't show regret for her decision, not in the final weeks of her pregnancy as she grew weaker, and not when she started to lose her vision as the cancer took its course, her family said.


Jenni's last words were about her son as he was placed beside her a final time, her father said.
If you own the rights to any of the images and do not wish them to appear on the site please contact us, and they will be promptly removed! He cut the specimen into sections about 1 cm square in area and 2 mm thick, and sketched a corresponding map of the sections, keeping each section separate and numbered to indicate its location on the map.3 He also painted the adjoining edges of the sections with different dyes to differentiate the superior edges from the inferior. Mohs first spoke of chemosurgery at a conference of plastic surgeons, he was greeted with nearly universal dismay and skepticism.
After all, we were the physicians best trained to recognize skin cancers, so we should also be the best at removing them.
At an international meeting, five other Mohs surgeons and I had a founders meeting at a dinner hosted by Dr. I found that the technique could also work well in other locations besides the head and face.
Kopf, MD, recognized the value of the technique and felt that doctors practicing it should be well trained.
In October of 1970, at the annual meeting of the American Academy of Ophthalmology and Otolaryngology (AAOO) in Las Vegas, Rex Amonette, MD, and I presented a number of cases of tumors on or around the eyelids treated with serial excisions of fresh tissue. The first year, I did about a third of my cases with the fresh tissue technique, and two thirds with the fixed.
For many years, melanoma was not treated with Mohs, because atypical melanocytes (the pigment cells where melanomas can develop) were difficult to assess using frozen sections. They know diseases of the skin, they know dermatopathology, and they are trained to do excisions and repairs.
Robins, Professor Emeritus of Dermatology at New York University Medical Center, was Chief of the Mohs Micrographic Surgery Unit there for more than 40 years. Hale is a Clinical Associate Professor of Dermatology at the New York University Langone Medical Center.
The nurse would later repeat the girl's words to comfort her family, as their worst fears were realized a day after Jenni's baby was born. 9 birth, Phillips learned that her daughter's decision to forgo treatment for tumors on her brain and spine so she could carry the baby would have fatal repercussions. She was taken to the family doctor, and an MRI scan found a small mass measuring about two centimeters wide on the right side of her brain. 15, 2010, and five days later was diagnosed with stage three astrocytoma, a type of brain tumor. With treatment, the teen was told she had a 30 percent chance to make it two years, Lake said. She managed to upload only three videos, though, as her treatments left her tired and weak. 20, 2010, Jenni appears distraught while a family friend records her having lunch with her mom.
Their adolescent relationship withstood the very adult test posed by cancer, the treatments that left her barely able to walk from her living room to her bedroom, and the gossip at school. She went to the emergency room early one morning with her boyfriend and when she returned home, her family members woke up to the sound of crying. Ririe would not discuss Jenni's care, citing privacy laws, but said, generally, in cases in which a cancer patient is pregnant, oncologists will consider both the risks and benefits of continuing with treatment, such as chemotherapy.
Her parents didn't think of it as a clear life or death decision, and Jenni may not have, either.
Nathan has legal custody of the child, who is primarily cared for by Nathan's mother, Alexia Wittman, 51. The cure rate for these techniques was about 90 percent when removing primary tumors, and only about 50 percent or lower when treating tumors that recurred after the initial treatment. Cure rates are 98-99 percent for primary lesions, and an astonishing 96 percent for recurrences unsuccessfully treated by other methods — impressive results for a technique that was barely known in the medical community half a century ago and aroused outrage when first announced as a skin cancer cure. When he applied the paste, Mohs found that he could excise the tissue without causing bleeding.


Reference marks were also made on the original surgical site to show exactly where each color-coded section had originated.
For example, a few patients were referred to me with skin cancers on their fingers that were scheduled for amputation, and I was able to save the digit. He was treating a patient with an eyelid basal cell carcinoma, and to avoid irritating the globe of the eye, he skipped the zinc chloride paste.
The next year, it was half and half, and the next year I was using the fresh tissue technique two thirds of the time.
With its unparalleled cure rates, Mohs micrographic surgery is the treatment of choice for select basal cell and squamous cell carcinomas, in addition to other less common skin cancers. Jenni, at 5 feet and 4 inches tall, weighed only 108 pounds at the full term of her pregnancy. With three tumors on her brain and three on her spine, Jenni was told her case was rare because the cancer had spread from her brain to another part of her body with no symptoms. They believed that since the tumors had already started to shrink earlier, she had a strong chance of carrying the baby and then returning to treatment after he was born.
He could then prepare frozen sections of the excised tissue, and placed them on slides to be viewed under the microscope. Thus, any further surgery that might be required would occur only in the part of the surgical site where a cancerous section had been found.
However, if a section revealed cancer cells, surgery would continue only in its corresponding portion of the surgical site.
We agreed to form a chemosurgery society and to hold our first meeting at the next annual meeting of the American Academy of Dermatology (AAD), in Chicago. Dermatologists began coming from around the country and other countries such as Germany and Portugal to train with me, which helped disseminate the technique to Europe and elsewhere.
Though I first doubted the fresh tissue technique, my study showed that the two techniques were equally effective.
Jenni Lake, who decided against treatment for tumors on her brain and spine so she could carry the baby, died of cancer. I began to put what he had taught me into practice, but I was initially met with the same kind of resistance he faced. Robins was the first to offer one-year fellowships in Mohs surgery and the first to teach Mohs techniques to dermatologists from other countries.
Hale practices dermatology at the Laser & Skin Surgery Center of NY, and lectures extensively on the prevention and treatment of skin cancer.
A protective dressing would be placed over the treated site to enhance penetration and absorption of the paste. By avoiding overly aggressive surgery and the removal of too much healthy tissue, it produced a much better cosmetic result. He has trained more than 70 doctors from around the world who are now leaders in dermatologic and skin cancer care.
You could resolve a skin cancer case in one day instead of many days — in fact, you could finish many cases in one day. Robins has published over 60 articles in leading medical journals and authored five books for the general public. He is the founder of the Journal of Dermatologic Surgery and Oncology and the Journal of Drugs in Dermatology. Robins an honorary fellow for outstanding contributions in dermatology; he has received its Award for Excellence in Education, 14 Gold Triangle Awards for Excellence in Community Education, and a Presidential Citation. He has been honored as a distinguished member of both the American College of Mohs Micrographic Surgery and the American Society of Dermatologic Surgery, and was awarded a Presidential Citation by the International Society of Dermatologic Surgery.



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