Making the Mohs of It

By Ashleigh Brilliant   |   July 12, 2018

Until a fairly recently, there was no Mohs in my life. Now there are two of them.

The first Mohs was a gift of Google; the second, of a crossword puzzle.

Here’s what happened: My dermatologist, whom I’ll call Dr. O, told me that the hard bump which had developed on the back of my right hand, was not the kind of pre-cancerous growth which he usually gets rid of with a single squirt of a cold spray. This one, according to the biopsy he’d ordered, was a kind I’d never had before, something called an “atypical fibro xanthoma.” It wasn’t terribly serious, but would require some excavation to get all the bad part out.

Before going back to Dr. O for the necessary operation, I did a little Googling and kept coming across references to a relatively new skin cancer treatment, called “Mohs Micrographic Surgery.” I didn’t know if it was even applicable in my case, but, when the appointed day came and I was sitting there in Dr. O’s office, and he was just about to start work on my hand, I casually asked if he was going to be using the Mohs method.

I fully expected him to say something like “Yes, of course I am,” or “No, it wouldn’t be suitable in your case.” But what he said instead was “No, I don’t do Mohs. If you want Mohs, you’ll have to go to Dr. H.” Having already waited several weeks for this appointment, and being anxious to get the whole thing over with, I protested that I didn’t necessarily want Mohs – I was just asking about it. But it was too late. At my very mention of Mohs, I had apparently made Dr. O afraid to proceed with his own less-advanced method, and he insisted on sending me to Dr. H.

Dr. H, it turned out, had not only been trained in Mohs, but had been partly trained by Mohs – Dr. Frederic Mohs, M.D. (1910-2002), a great American dermatologist who had developed the technique. But although Dr. H treats hundreds of patients, he told me at my preliminary appointment that I was the first atypical fibro xanthoma he had seen in a year. I really didn’t know whether to be glad of this distinction. I almost wished that, back in Dr. O’s office, I’d kept my big mouth shut.

But things slowly went ahead. After another week waiting, I was finally “Mohsed” by Dr. H. I had to go back several more times for bandage changing and removal of stitches. And I was shortly due to see Dr. H for one final inspection.

That morning I engaged in an activity which I find quite enjoyable – taking a walk and doing a crossword puzzle at stops on the way. But for me, the very first clue, number 1 Across, was even more of a puzzle than anyone intended. What it asked for (in  four letters) was “The soft end of the Mohs Scale.”

What! Another Mohs! (Or could this possibly be the same one?) Before my walk was over, I had got the answer to One Across, just by solving 1, 2, 3, and 4 Down. The answer was “TALC.” Once home, I consulted my Webster’s New World College Dictionary, to learn that I did indeed have here another Mohs, but also a man of science, and one with the confusingly similar name of Friedrich Mohs. This Mohs lived from 1773 to 1839. He was a German mineralogist, and his scale was a ranking of the hardness of various minerals, with talc at the soft and diamond at the hard end.

By now, you know how happy I am to display my fragments of ignorance to the nearest dermatologist (or for that matter to anybody else within range) – so imagine the glee with which I waved my crossword puzzle that afternoon under the nose of Dr. H! I felt fairly certain that he must at least be aware of that other Mohs, who was famous enough to get himself into Webster’s Dictionary and the Universal Press Syndicate Crossword Puzzle – though not hitherto into my own consciousness.

But Dr. H disappointed me. He had never heard of the mineralogist Mohs and his Scale of Hardness! What narrow worlds we live in.

But my right hand (one of my favorites) healed nicely – without any application of talcum powder, although that would have been, so to speak, Mohst appropriate.


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