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SALT LAKE CITY — First lady Jill Biden is scheduled to have a procedure next Wednesday — Mohs surgery — which is relatively common in Utah because the state has a lot of skin cancer cases, according to a Utah doctor.
Dr. Alice Frigerio, a surgeon and cosmetic dermatologist at the Huntsman Cancer Institute, says Utah is the state with the highest incidence of melanoma and skin cancer, and the institute's surgeons perform about 5,000 Mohs surgeries a year. This is likely due to the high number of people who descend from northern Europe, the high altitude and the amount of time Utahns spend outdoors, Frigerio said.
The White House says the 71-year-old first lady will have the surgery on Jan. 11 at Walter Reed Medical Center in Bethesda, Maryland.
The First Lady's press secretary tweeted a memo from Dr. Kevin O'Connor, physician to the president, which said a small lesion was found above Jill Biden's right eye. The doctor said it was being removed due to an "abundance of caution."
During a routine skin cancer screening, a small lesion was found above the First Lady's right eye. Memo here from Dr. Kevin O'Connor, Physician to the President, with more information on the First Lady's upcoming outpatient procedure to have it removed and examined. pic.twitter.com/DIQrnjtZFc
— Vanessa Valdivia (@vvaldivia46) January 4, 2023
Mohs surgery
Frigerio said typically a general dermatologist will identify a lesion and do a biopsy. By the time someone comes in for a Mohs surgery, they already have a diagnosis and know where the lesion is, but they do not know how large it is.
"Sometimes we don't really know how involved it is until we really do the surgery," she said.
Mohs surgery is unique because the doctor will remove one layer at a time, with a goal to remove all of the cancerous cells, while keeping as much of the non-cancerous cells as possible. It has a 98% to 99% cure rate, Frigerio said, and is done by highly specialized surgeons.
The surgery has been around since the 1930s, but Frigerio said it has evolved. During the current procedure, surgeons remove small layers of tissue and examine them under a microscope; if cancerous cells are found, they will repeat the process. Since the cancer addressed through Mohs surgery is often in an eyelid, lip, ear or nose, a few millimeters can make a large difference in the cosmetic outcome, she said.
Typically people are able to leave between two and six hours after the outpatient surgery, Frigerio said, but the recovery time varies significantly based on how large the lesion is and whether there was a lot of reconstruction done. She said an average recovery may be six days.
Depending on how close the lesion is to Biden's eye, Frigerio said it is possible she may experience bruising near her eye which could then travel down her cheek.
Prevention
Although genetics can lead to a higher chance for skin cancers to develop, there are steps people can take to avoid skin cancers and the need for Mohs surgery. Frigerio suggested sunscreen, wearing long sleeves, polarized sunglasses and wide-brimmed hats.
She suggested starting with protecting children from sunburns, which can impact whether they get skin cancer later.
"Sun damage in the childhood and teenage years has an impact on the risk of skin cancers because some skin cancers are related to the cumulative sun damage over a lifetime," she said.
For sunscreens, Frigerio suggested mineral sunblocks which have zinc or titanium to actually deflect the dangerous UV rays. She also said to look for an SPF of over 30 or 50. If it is going to be hard to reapply sunscreen, covering with clothing is the better option.
If people have a close relative who has had skin cancer or have had skin cancer themselves, she said it could be a good idea to be screened regularly.
