Archive for Remedies for Health and Menopause

The North American Menopause Society, NAMS,  has recently released a new position paper on the use of hormone therapy during and following menopause. An analysis of several studies and data has shown that hormone therapy is not as dangerous or onerous as believed 10 years ago after the initial release of the Women’s Health Initiate study results.

The Women’s Health Initiative was designed to determine if HRT was cardioprotective; as well as to help determine if HRT caused an increase in breast cancer. This study was stopped prematurely due to an increase in cardiovascular events including stroke, heart attack and blood clots. Hormone therapy was quickly blamed for this increase in cardiovascular events, and consequently usage has plummeted.

You may be asking what is new about all this information?

Researchers have been continuing to analyze the data from this study, and have come to some conclusions which have helped guide NAM’s new position paper. This is what they have determined:

  1. Most cardiac events occurred in women over 60 who were placed on hormone therapy 10 or more years after menopause.
  2. Women who underwent hysterectomy and were placed on estrogen without progesterone had a lower rate of breast cancer, therefore taking estrogen for up to 7-8 yrs was not associated with increase risk of breast cancer.
  3. However, HRT started at time of menopause was associated with slightly higher risk of breast cancer than when started a few years post menopause.
  4. Women on estrogen therapy (ET) and estrogen/progesterone therapy(EPT) had lower rate of cardiovascular events when HRT was started at time of menopause, as opposed to several years post menopause.
  5. The types of estrogen and types of progesterone may influence risk of breast cancer and cardiac events.

What does this mean for you?

The recommendations suggest that you can expect the have your hormone therapy customized to your particular medical situation,  including consideration for your risk for breast disease and heart disease.

For those of you who have had a hysterectomy, you could reasonably take your estrogen therapy for up to 7 years without significantly increasing your risk of breast cancer.

For those of you who still have a uterus, you would want to limit your use of HT for 3-5 years. After this, your risk of breast cancer increases.

The type of progesterone therapy may affect the risk of cardiovascular events. A natural progesterone, such as Prometrium, may have significantly less risk than synthetic progesterone, for both cardiovascular events and possibly breast cancer.

The route of delivery of estrogen may lessen the risk of HT. Topical estrogen, or estrogen patches may have less risk of thrombotic events; than oral estrogen.

Estrogen is the most effective therapy for vulva and vaginal atrophy, with topical vaginal cream, ring and suppositories being superior to oral estrogen.

Compounded Bio-identical hormones should only be used if an allergy to a component of federally approved estrogen or progestin hormone therapy exists. These compounded hormones have not been tested and may contain levels of hormones or ingredients that are harmful. For this reason,  safety cannot be established as clinical trials proving safety have not been performed.

Hormone therapy can be very helpful when you are first experiencing menopausal symptoms. Now, with this statement paper, there is more guidance on safety of HRT use. Compounded Bio-identical Hormones are very popular, but their safety has not been establishes in the types of studies that this position paper discusses. There are many safe options for women that include patches, creams as well as pills; and this allows flexibility in dosing. This is is a form of customization.

This is information that you can use when you see your medical provider. Write in and share your own experience with HRT and whether or not it has helped, and even which preparation you used (your information is anonymous to our readers). It is through sharing information that we can enlighten one another about menopause and strategies to ease the common problems.

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Osteoporosis part 2

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You have seen part one of Osteoporosis and learned that bone is dynamic tissue, constantly being remodeled. When additions don’t keep up with destruction you get softening of bone called osteopenia if it is mild or osteoporosis if it is more advanced.
Here is video #2 in a series of 3 on this topic.

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Osteoporosis part 1

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What is osteoporosis? Who is at risk? What can be done to prevent it? How is it treated? This is the first of a 3 part series. Parts 2 and 3 are in the membership area. Sign up on the home page to become a member and gain access to these additional videos.



Anxiety during Menopause

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This is another of the 35 symptoms of Menopause.

Sign up on the home page to accept my gift of membership worth $120. Then visit the membership portion of the blog, view more videos and signup to be notified about a series of live teleseminars I will be hosting. I hope to be talking with you soon. Only members have access to the signup form.


Kegels equals Better Sex and improved urine control

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Pelvic Relaxation syndrome is a common condition of women as they age. It is the problem of sagging but instead of external symptoms, these are internal and involve the pelvic muscles, ligaments and organs like the urinary bladder, intestines and uterus. Weakness of these muscles can cause a person to be incontinent of urine. Initially this is when coughing hard, sneezing and then jumping and at its worst just when the bladder is full.

Along with dryness in the genitals and less desire this represents yet another sexual challenge to the post-menopausal woman. It can result in less stimulation, discomfort and out right pain. Listen to Anne as she explains about this common and aggravating problem.

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Menopause affects Your Smile

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You know the main effects of Menopause on your being. You know what friends and family have experienced. Even so, lets make a list:

  • No more periods after menopause
  • Fatigue
  • Sleep problems
  • Weight gain
  • Loss of Sexual desire
  • Bladder Problems
  • Vaginal Dryness and irritation
  • Dysparunia (painful intercourse)
  • Dry Eyes
  • Dry Mouth
  • Change in your ability to taste
  • Burning Mouth
  • Increased Tooth Decay
  • Increased Gum Disease
  • Osteoporosis
  • Stiffness and Decreased Muscle Mass

Some of these changes are part of aging just as menopause is. The list and this discussion are not to make you anxious or fearful. Some of these will not happen to you. Some that do happen may be quite mild. I want you to focus on what you can do today and each day to improve and prevent problems.

This post isn’t about every problem of menopause and what to do. It is about your smile and how that influences your health.

Your smile would seem to have two components. The first has to do with your perception of life. Is it good, satisfying, enjoyable? The pleasant sensation of satisfaction with life allows us to smile. Different things create smiles in different people. Most smile when they are pleased, happy, satisfied, safe and all their basic needs are met.

Some people meet life and all its problems with humor. No matter what life throws at them they smile, laugh and go on. My youngest sister always smiled and sometimes giggled when we were kids and my Dad was correcting us. My other sister and I would tell her to be quiet, but for her then and now everything had a humorous glow and she laughed. Even now, when we talk of some sad things, she will be sad for a moment and then remember something she liked that happened and will smile and recall that moment of joy or humor that occurred in the darkness and laugh gently. She is one of my favorite people – you can not be around her without feeling good.

The other aspect of your smile is your teeth. I rarely smile. Not because I don’t want to but it is a family trait that we have small mouths and large teeth. Therefore they are crooked. I refer to mine as “summer teeth” – some are here and some are there! I don’t smile because I don’t like the way they look. One perverse thing about me is that I will smile when things are tense. I have been in some serious situations and that is when I will get this big smile. I think I like the adrenaline but it isn’t always reassuring to others with me. Sorry, I am digressing here. You aren’t going to smile if your teeth aren’t nice either.

Menopause can affect your smile. There is a natural increase in gingivitis – gum diseases – as we age. Gums recede, Teeth can loosen and be lost. Menopausal women have less estrogen. Estrogen receptors are in the mucosal lining of the mouth and in the salivary glands. Without it – estrogen -post menopausal women have drier mouths. This increases susceptibility to tooth decay, decreases the amount of nutrition available from food and affects overall health. If you loose teeth, have unrepaired tooth decay and don’t get things fixed you won’t smile as much.

What can you do?  Prevention!  Avoid sugars! Brush immediately and gently after meals. I use flossers to clean my teeth after eating. They are cheap, fit in a small bag in my desk drawer or brief case and are good for my gums and yours too. I also recommend along with my dentist – Dr. Jerry terAvist of Durham NC – a Phillips Sonacare tooth brush. I actually bought mine for $90 thru my Dentist. I love it and find the smaller pediatric brushes work better on my crooked teeth.  (We do not receive any money from Amazon if you make a purchase)

Get regular dental checkups!  Very important.

Prevent osteoporosis -

  • take vitamin D3,
  • Perform resistance exercises,
  • get 800mg of calcium per day (the best supplement is calcium citrate),
  • avoid high Glycemic load foods. Click on the link and scroll to the end of the article to see a table of foods.

(conversion factor 30 gm = one ounce so 90 gm or grams = 3 ounces)

Talk to your Dentist about dry mouth, taste sensation changes and oral burning sensations. Ask for some literature on oral health during menopause. If you don’t find help there, ask us, we will find you a resource close to where you live.

Hey, Anne gives this membership to readers as a gift. It is worth$120! It allows you to leave comments that can only be seen by other members not everyone on the web. You have to do something to become a member – sign up!

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Recently the USPTF (U.S Prevention Task Force) amended its’ recommendation for when post menopausal Osteoporosis Model of Spinewomen should receive bone density studies. Prior to the current recommendation, only women 65 or older have been urged to have bone density studies to determine their degree of bone thinning. This is called osteoporosis and places a woman at risk for a hip fracture and vertebral fracture and collapse. The USPTF now recommends including women whose risk factor for osteoporosis may be equal to or greater than that of a 65 year old woman. This is an important issue that you can address with your provider at your yearly physical.

Hip fractures can be a significant adverse event for you or a loved one, as it can increase risk of serious infections and even death due to immobility. Additionally, vertebral fractures or collapse can significant pain and also carries increased risk of infections and death. It is estimated that by 2012, roughly 12 million Americans older than 50 years are expected to have osteoporosis. One half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime. There are several tools you medical provider can use to determine if your risk for osteoporosis warrants a bone density study.

It is hard to imagine that this can happen to you when you feel so strong and mobile compared to elderly relatives or acquaintances you may see or interact with. It could be happening to you now, even in your relative youth.

This is something I am seeing first hand with my mother. She has always been strong and active, playing tennis well into her late 70′s. Swimming laps into her 80′s. Always eating a healthy diet with milk and cottage cheese daily and taking her calcium tablets. Unfortunately for my mother and other women of that generation, the information on diet and osteoporosis was not generally disseminated when she was in her 40′s and 50′s. Despite her healthy life style, bone thinning most likely began decades ago.

That does not have to be the course of events for you! We know so much now and although some therapies come and go in almost fad-like fashion, bone strength seems like a “no-brainer”. Yes, there has been some recent controversy on the quality of bone that the bisfosphonates produce; and the USPTF does not seem to be jumping forward on recommendations for high doses of Vitamin D supplementation. But keeping bones strong through a healthy diet and exercise is something that everyone can do and benefit from. Maximizing food consumption to include vitamin packed vegetables, low fat dairy if you are not sensitive, as well as healthy nuts can provide you with natural occurring calcium readily absorbable.  Weight bearing exercise and resistance work all contribute to bone health as well as cardiovascular fitness.

You can prevent some of the pain of osteoporosis by staying active, eating a healthy diet and ensuring you consume adequate calcium and vitamin D. We have talked a lot recently about the benefits of achieving a healthy weight through healthy diet and regular exercise. Prevention of osteoporosis is another reason!

Become a member! Our free gift is worth $120. Just use the form on the home page to sign up.

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BREAST CANCER-Are you at risk for a certain type?

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White spot is Breast Cancer seen on a Mammogram

White spot is Breast Cancer seen on a Mammogram

Breast Cancer is a very frightening illness for a woman to contemplate.  Our breasts are one of the symbolic parts of our anatomy which define us as women. The diagnosis of cancer is hard enough to hear, but when it is breast cancer, it strikes to the heart and soul of a woman.

There are many types of breast cancer and each of them carries a different prognosis and cure potential. There is much research into causes, treatments and prevention currently ongoing. Now more than ever there are better treatments for breast cancer, and many women who have received this diagnosis live for decades following diagnosis and treatment.

To understand the different types of breast cancer, it is important to know the anatomy and different parts of the breast. The breast is made up of glandular, fatty and fibrous tissue.

The glandular tissue includes lobules which lie deep in the breast and are the milk producing glands; and the ducts which are responsible for carrying milk to the nipple.

The fibrous tissue surrounds the glandular tissue and adds some support to breast tissue.

The fatty tissue surrounds the glandular and fibrous tissue and gives the breast the soft consistency.

Within all of this are the lymph system and the blood vessel system. When a woman goes through menopause, the glandular tissue shrinks, the fibrous tissue looses some of its support and the breast increases the amount of fatty tissue. This decreases the density of the breast and aids in mammogram detection of abnormalities.

What types of cancer can affect the breast?

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DCIS: this stands for Ductal Carcinoma in Situ. This is the most common type of noninvasive breast cancer; it is confined to the ducts of the breast and has not spread into surrounding tissue or distant organs. It is detected on mammogram, 1:5 cases (20%) of breast cancer will be DCIS and it is felt to be almost completely curable. If necrosis is present on biopsy however, this signals the cancer is more aggressive and may be capable of spreading. A sub type of DCIS is Papillary Cancer.

LCIS: this is Lobular Carcinoma in situ. This cancer begins in the lobules which are the milk producing glands of the breast. It does not extend beyond the wall of the lobule, hence the term “in situ”. It is felt to have a low likelihood of becoming a metastatic (spreading) cancer however statistically its’ presence raises the risk of invasive cancer in the same or opposite breast. Researchers are not sure why this is the case.

Both of the above types of breast cancer are felt to have a low malignant potential. This means that they are unlikely to spread or invade surrounding healthy breast tissue, or spread by the lymph system and blood stream to other organs and cause a cancer in those organs.

The types of breast cancer discussed below are all types with a malignant aspect to them, meaning they will grow into surrounding breast tissue and interfere with normal functioning, and can spread to other organs and cause the same diseased activity. Women die from breast cancer when the organs the cancer has invaded can no longer work normally to sustain life. Treatments are aimed at both preventing spread to other organs, as well as trying to  destroy the cancerous breast tissue and any metastatic cancer tissue.

Invasive/Infiltrating Ductal Carcinoma: this is the most common invasive breast cancer. It accounts for 8 out of 10 invasive breast cancers diagnosed. It begins in the ducts and spreads through the walls into the fatty tissue. It is able to metastasize through the lymph system to other organs. A few additional subtypes are Tubular and Paget’s disease.

Invasive Lobular Carcinoma: as the name suggests, this begins in the lobules or milk glands and can spread locally as well as metastasize to other organs. It is more rare and only accounts for 1:10 diagnosis of invasive breast cancer. It is difficult to find on mammogram

Inflammatory Breast Cancer: This type is more uncommon than the above types and the cancer’s DNA behaves differently than other types of cancers. Its’ presentation is different in that there is no specific lump or cluster of calcifications as seen with the above types of breast cancer. Rather, it causes blockage of lymph vessels in the skin which in turn causes a redness and warmth to the skin of an area of the breast. Along with this redness and warmth is a thickening and pitted appearance likened to the peel of an orange. It accounts for 1-3% of breast cancers and usually occurs in younger women and there is a slightly higher incidence in African American women. The breast becomes larger and this is what is seen on mammogram, it is often mistaken for mastitis. MRI is the more sensitive imaging technique for evaluating this cancer. This is a very aggressive cancer and it is difficult to treat successfully as it is usually advanced when discovered. The 5-year survival rate is 40% as compared to 87% for other types of breast cancer.

Triple Negative Breast Cancer: this will be further explained below, but these cancers are usually very invasive ductal cancers with no protein receptors which make them amenable to treatment. They are usually present in younger women and slightly higher incidence in African American women. They are rapidly growing cancers.

When a breast cancer is diagnosed, biopsied and/or removed, several tests are done on the tissue to determine how the specific cancer will respond to therapies. This helps to determine a treatment course and to some extend predict the response and potential survival rate for the patient. These tests are also used to additionally categorize the type of cancer. There are receptors on the walls of the cancer cells which are proteins which can turn on growth when triggered.

The common receptors tested are for estrogen and progesterone. These proteins (receptors) allow these hormones which are naturally occurring in a woman’s body to attach to the cancer cell and fuel its growth. A breast cancer which has these receptors will be called ER + or PR+, or both ER/PR+, and likewise ER-, PR- or ER/PR-. ER or PR positive breast cancers actually have a better prognosis because they can respond to treatment. 2/3’s of breast cancers will contain at least one of these proteins.

HER2: this is a growth promoting protein. There are genes within the breast cell that when “turned on” will instruct the cell to make this protein. HER2 cancers have increased amounts of HER2 genes which leads to increased amounts of this protein. This type of cancer can spread and be more aggressive, however certain chemotherapy agents have been developed which can effectively treat this type of  breast cancer. Any of the above cancers discussed with the exception of the IN-SITU cancers can be determined to be ER or PR + or -; and they may or may not have HER2 protein.

BRCA1  AND BRCA2: many of you have heard about this type of genetic testing. These terms do not relate to a specific cancer but rather a genetic tendency or risk factor for developing breast cancer.

This would be a gene that is passed down within families. BRCA 1 and 2 genes are the most common causes of hereditary breast cancer. Normally, the BRCA1 and BRCA2 genes help prevent cancer by making proteins that prevent abnormal cell growth. When there is an inherited mutation on these genes, they are unable to prevent this abnormal growth. The risk of developing breast cancer with these gene mutations is as high as 80%. These cancers usually occur earlier in life of the women with these genetic mutations. The cancer often occurs bilaterally or in both breasts but not necessarily at the same time.  There is an increased risk of ovarian cancer with these gene mutations. In the US, there is an increased risk of BRCA1 and BRCA2 in women of Ashkenazi Jewish descent.

There are other gene mutations that are not as common.

ATM is a gene which helps repair DNA when functioning normally. It controls cell division. Researchers have yet to discover why a mutation of this gene causes cancer.

P53 is a tumor suppressor gene which plays a role in cell growth when functioning normally. When damaged, it looses the ability to block cell growth. 50% of all cancers of all types will have a p53 mutation. This mutation carries increased risk of brain cancer, leukemia, sarcoma as well as breast cancer when a mutation exists.

PTEN is a gene which regulates cell growth. It is felt by researchers to be the most important tumor suppressor gene yet discovered. When functioning normally, it protects a cell from progressing to a cancer. It may cause cell death if such a precancerous change in the cell occurs. Mutations of this gene are associated with large numbers of cancer types, including breast.

CHEK2 is an inherited genetic marker for breast cancer similar to BRCA1 and BRCA2. The CHEK2 gene normally produces a protein which prevents cells from growing uncontrollably. When mutated, it cannot regulate cell growth and carries a 3 fold increased risk of breast cancer .

The good news about breast cancer is that we know more about it.

Diagnosis and tissue typing have become more sophisticated resulting in improved therapy and improved survival.

Now more than ever women are surviving breast cancer and living long and productive lives.

It is a very frightening diagnosis to consider, and women often delay getting screening tests and exams to aid in early diagnosis because of this fear.

It is vitally important for a woman to identify her risk factors for breast cancer and improve her lifestyle to reduce risk factors which can be controlled.(risk factor is anything, genetic or lifestyle, that increases the risk for a particular disease)

These risk factors have been discussed in a prior posting on our website. I encourage readers to familiarize themselves with those risk factors and begin a program which helps you to reduce them.

I also encourage readers talk with their medical providers about their concerns regarding mammograms and screening tests.

Remember-most breast cancers caught in  early stages carry an excellent prognosis for long survival.


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Bones of the foot

Bones of the foot

Recently news  reports indicated that Fosamax, used to treat osteoporosis and prevent hip fractures, actually caused fractures to occur. Many patients asked me, how is this possible and should I stop my medication? While this  has no doubt caused much consternation and confusion to women taking this drug, it is important to understand exactly what was found and why.

Theses drugs, the bis-phosphonates (Fosamax and others),  work by slowing the activity of osteoclasts in bone. These osteoclasts are responsible for bone destruction and in younger bone, osteoclast activity,  is matched in activity by osteoblasts, which create bone. This allows a bone turnover where new bone is formed and older bone is reabsorbed making way for the newer bone.

In osteoporosis, the osteoblasts have slowed in their formation of bone, however resabsorption of bone has continued at its usual rate. Because of this imbalance, bone slowly thins placing a woman at risk of a break or fracture. Bone production is most affected by lower production of estrogen.

The bisphosphonates are very effective in helping to produce new bone,

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but it is now being speculated that this bone may not be as healthy as natural bone. For women that have enough bone loss to place them at serious risk for a fracture however, this bis-phosphonate induced bone can be protective to some extent. In recent studies by Orthopedic Surgeons, it was noted that bone integrity was improved early on in therapy but that benefit was lost after more than 4 years of treatment. As with many things in medicine, there are risks and benefits to be weighed when considering osteoporosis medication. It is important to discuss this with you provider before stopping any medication.

Orthopedic Surgeon reading an Xray

Orthopedic Surgeon reading an Xray

There are other ways to treat osteoporosis and other classes of medication, however the bisphosphonates have been the easiest to take and most popularly prescribed class of medication used thus far. Hormone therapy is effective in preventing and treating osteoporosis, these hormones come with risk factors discussed in other posts on this blog.

Exercise and diet also play an important role in preventing and treating osteoporosisMuscle building exercise helps to activate the osteoblasts to lay down new bone, calcium in our diet helps to make that bone strong, and vitamin D helps our body to absorb and process the calcium. So, Muscle building exercise of 90 minutes a week is recommended for bone health. An increased exercise time of 150 minutes a week is recommended for heart health and to lower insulin resistance. This muscle building exercise does not have to be high impact;  brisk walking is excellent, as far as we know now, swimming will not help your bones .

Calcium supplements will suffice to replace or augment dairy products.  1200-1500 mg of calcium daily is the recommended dose for post menopausal women. There are several different types of supplements and they are all good but are tolerated differently, experimentation will yield the best tolerated brand for any given person.

Vitamin D3 capsules or pills are recommended as it is difficult to get adequate Vitamin D in the diet. D3 or ergocalciferol is the recommended type as this last longer in the body. It is important to get a brand that does not have Vitamin A in it, as it would be easy to get too much Vit. A and the body cannot regulate this easily.

As always, if you become concerned about the medication you are taking, discuss this with your medical provider before discontinuing any treatments or medications.

A recording of this post in MP3 format is available below.


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Skin – Wrinkles, Skin Cancer and proper Skin Care

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Dr. Sue Ellen Cox

Dr. Sue Ellen Cox

Dr. Sue Ellen Cox, pictured to the left, is a board certified Dermatologist practicing dermatology in Chapel Hill, NC.  She is one of the founding partners of Aesthetic Solutions and contines to be a managing partner in that practice.  She is also an Associate-Professor of Dermatology at the University of North Carolina Chapel Hill Medical Center. Drl Cox was interviewed in her home and some family interaction is evident during the interview.

During her talk with Anne Vaillancourt PAC, she discusses the following topics:

Adult Acne, Dry Skin, Winter Itch, Eczema, Nummular Eczema, Hand dermatitis, Thyroid disorder as a cause of itching, Vitamin D, Wrinkles fine lines and the causes of them, Treatments for aging skin, Rosacea, skin cancer, basal cell, melanoma


Drugs she discusses are:

Spironolactone for adult acne

Atopiclair for eczema and very dry skin

Mimyx cream for eczema and very dry skin


Retinoids – Retin-A


Glycolics    AHA and Lactic acid

UVA and UVB sunscreen – pay attention to her explanation of SPF as applicable to UVB only – UVA rays do the damage so pay attention there.

Titanium Dioxide, Zinc Oxide, Mexoryl,

Metrogel topical cream (not to be confused with the vaginal variety)

Revale, Aczone, Finacia all mentioned along with Pulsed dye laser all for Rosacea

for skin cancer PDT or photo dynamic therapy, immune modulators like Aldara, Mohs micrographic surgery,