Surgical dermatology is a specialized field within dermatology that focuses on the surgical treatment of various skin conditions, including benign and malignant growths, lesions, and skin cancers.
At Dartmouth Dermatology, our surgeons are trained to perform a wide range of surgical procedures, from minor surgeries such as excisions and biopsies to more complex surgeries involving skin cancer removal and reconstruction. These procedures aim to not only remove the affected area but also to restore the function and aesthetics of the skin.
Mohs surgery, named after Dr. Frederic Mohs who developed the technique in the 1930s, is a precise and highly effective surgical procedure primarily used for the treatment of certain types of skin cancer, especially basal cell carcinoma and squamous cell carcinoma. It is often recommended for skin cancers located in cosmetically sensitive or functionally critical areas such as the face, hands, feet, or genitals, as well as for tumors with ill-defined margins or those that have recurred after previous treatment.
Mohs surgery is known for its high cure rates and tissue preservation, as it ensures minimal removal of healthy tissue while effectively eliminating cancerous cells. This approach makes it an ideal option for treating skin cancers, particularly those that are large, aggressive, or have ill-defined margins. Additionally, Mohs surgery offers the advantage of immediate microscopic examination, allowing the surgeon to confirm the complete removal of cancer cells during the same surgical session, thus minimizing the need for additional procedures.
The Mohs surgery procedure involves several key steps:
The visible tumor is removed along with a thin layer of surrounding tissue, which is then carefully mapped and labeled for orientation and analysis.
The excised tissue is frozen, sliced into thin sections, and stained for microscopic examination. The surgeon then analyzes the entire surgical margin to detect any remaining cancer cells.
If cancer cells are found at the edges of the excised tissue, the surgeon precisely identifies the locations and removes additional thin layers of tissue only from the areas where cancer cells remain.
After the tumor has been completely removed, the surgical site is reconstructed to optimize both functional and cosmetic outcomes. Depending on the location and size of the wound, various reconstructive techniques may be employed, including primary closure, skin grafts, and local tissue rearrangement.