Expert Skin Cancer Surgery and Reconstruction
The Center for Dermatology, Cosmetic and Laser Surgery is committed to excellence in the diagnosis and surgical treatment of skin cancer. Our Mohs Micrographic Surgery program provides highly specialized treatment for basal cell carcinoma, squamous cell carcinoma, melanoma, and other high-risk or complex skin cancers.
Mohs surgery offers the highest cure rates for many types of skin cancer while preserving as much healthy tissue as possible. Our fellowship-trained Mohs surgeons have extensive experience treating tumors in cosmetically and functionally sensitive areas, as well as large, recurrent, aggressive, and otherwise complex skin cancers. Following tumor removal, we provide individualized reconstruction with an emphasis on restoring both function and appearance.
Our team works closely with referring dermatologists and other specialists to provide coordinated, efficient care from diagnosis through treatment and follow-up. Patients benefit from comprehensive skin cancer expertise, advanced surgical techniques, and reconstructive care in a single practice.
What Is Mohs Surgery?
Mohs Micrographic Surgery (MMS) is a surgical technique developed by Dr. Frederic Mohs. It involves the surgical excision of cancerous tissue and the systematic microscopic examination of all cut surfaces for 100% margin control.
Each excision is correlated with a drawn map of the wound — which is why the technique is called “micrographic” surgery. This mapping allows the surgeon to identify precisely where any remaining cancer cells are located, so additional tissue is removed only where it is needed. The result is complete removal of the skin cancer with maximum preservation of healthy surrounding tissue.
Why Choose Mohs Surgery?
Mohs surgery is the gold standard for the treatment of the most common skin cancers, including basal cell carcinoma and squamous cell carcinoma. It is also used for select melanomas and other high-risk or aggressive tumors. These cancers arise from the top layer of skin cells.
Cancer is tissue that grows out of control. Both basal cell and squamous cell carcinoma typically enlarge from the point where they first appear and usually do not spread to other parts of the body. However, if not completely removed, they can invade surrounding tissue and destroy structures in their path — which may result in disfigurement of important features such as the eyes, ears, and nose.
Unlike internal malignancies, skin cancers are usually recognized by dermatologists and treated at an early stage, which typically results in a cure.
Mohs surgery is particularly well suited for skin cancers that are:
- Located on the face, ears, nose, eyelids, lips, hands, or other cosmetically and functionally sensitive areas
- Large, aggressive, or rapidly growing
- Recurrent, or that have returned after previous treatment
- Poorly defined, with borders that are difficult to identify
How Is Mohs Surgery Performed?
Mohs micrographic surgery is performed in five steps:
- Bulk removal of the tumor with a skin scraping.
- Surgical removal of a thin layer of remaining tumor visible to the naked eye.
- Mapping and slide preparation — a “micrographic” map of the removed tissue is drawn, and glass slides of the skin are prepared with special stains to highlight and diagnose the tumor.
- Microscopic examination of the prepared slides in our on-site laboratory.
- Additional excision if needed — if tumor is still present, further tissue is removed at the positive margin and steps 2 through 4 are repeated. Once the examined area is free of tumor, options for repairing the surgical site are discussed.
Because each layer is examined before the next is taken, the procedure is completed in stages over the course of a day. Patients should plan to be in the office for several hours.
Reconstruction and Repair
Once the skin cancer has been completely removed, our surgeons discuss the best approach for repairing the surgical site. Reconstruction is individualized to each patient and may include:
- Simple sutured wound closure
- More complex flaps or skin grafts
- Allowing the site to heal on its own, in certain circumstances
Because our Mohs surgeons have advanced training in reconstruction, the site can generally be repaired the same day, in our office. There is usually no need to have this done at another office or facility.
Who Performs Mohs Surgery?
A Mohs surgeon is typically a board-certified dermatologist who has passed an examination by the American Board of Dermatology (ABD) and completed one to two years of additional training in a Procedural Dermatology fellowship approved by the Accreditation Council for Graduate Medical Education (ACGME). After these credentials are completed, the Mohs surgeon is elected to become a fellow of the American College of Mohs Surgery (ACMS).
Only a limited number of medical offices are equipped to offer Mohs micrographic surgery. The technique is time-consuming and requires highly specialized training — the dermatologist must function as a surgeon to remove tissue and as a pathologist to examine prepared slides in a certified, on-site laboratory in order to map the tumor.
Patients should always confirm that their Mohs surgeon is a board-certified dermatologist and a Fellow of the American College of Mohs Surgery.
Why Choose the Center for Dermatology?
Our practice is an ideal place for this procedure for several reasons:
- Experienced Mohs surgeons. Drs. Robert J. Roth and Hayes B. Gladstone bring a combined 50+ years of experience in this specialized technique.
- Advanced reconstructive training. Both physicians completed specialized fellowships with additional training in reconstruction, allowing tumor removal and repair to be completed in a single visit.
- On-site laboratory. Tissue is processed and examined in our own certified lab, which keeps the process efficient and eliminates outside delays.
- Coordinated care. We work directly with referring dermatologists and other specialists to keep care efficient from diagnosis through follow-up.
- Comprehensive expertise in one practice. Diagnosis, surgery, and reconstruction are all handled by our team.