What is
University Dermatology, Inc.?
University Dermatology, Inc. is a Brown University affiliated dermatology practice based
on the Rhode Island Hospital campus. We also have a satellite offices in Warwick. University Dermatology
physicians are faculty in the department of dermatology, Brown Medical School. This practice covers all aspects of dermatology, including pediatrics and
adult dermatology, skin cancers and cosmetic procedures, dermatopathology and
phototherapy.
For more information please visit Brown University's department of dermatology website.
Tell me about the Mohs surgery unit at University Dermatology.
Raymond Dufresne, Jr., MD, the director of Mohs and dermatologic
surgery, developed
the first Mohs surgery unit in Rhode Island in 1989. The unit was moved to
the Rhode Island
Hospital campus in 1997. Nathaniel Jellinek, MD, joined the unit as co-director in 2005. We have treated over 15,000 cases of skin cancers in Rhode
Island with Mohs surgery. The Mohs surgery unit is more than 2,000 square feet and includes
five surgery suites, an integral lab,
and a dedicated patient waiting area for privacy. The lab is Clinical Laboratory Improvement Amendments (CLIA) inspected and
approved by the federal government.
What should I expect on the day of my consultation?
The Mohs
surgery team will complete a consultation during which we will ask that you complete a brief
form about your past medical history. The consultation
is to ensure you understand why you have been referred
for the procedure, what options you have for treatment and what to expect the day of your surgery. The consultation
also helps the doctors determine if you are medically
prepared for the procedure. After this consultation, you
will be scheduled for surgery.
What should I expect the day of my surgery?
You should eat your regular breakfast and take all of
your medications as usual on the day of surgery unless
specifically told otherwise. A nurse completes a
preoperative evaluation. The doctors will clean the
surgical field with an antiseptic and inject you with local
numbing medicine. You will not be put to sleep; however,
please have someone drive you home.
Once the surgical area is numb, the skin cancer will be cut out,
sent to the lab and made into microscope slides. The process
may take 30-45 minutes. If there is some cancer left based on the microscopic exam, the
process of removing tissue is repeated until the entire tumor
has been completely removed based on microscopic
examination.
While most patients have their skin cancers removed in two or
three "rounds" of surgery, it is impossible to know exactly how
many rounds it will take for your skin cancer. Expect to be here
for half of a day. Similarly, it is impossible to know exactly
how large your wound will be until the surgery is completed.
Once the skin cancer has been removed, the wound is repaired.
The repair may be performed by suturing the wound directly,
rearranging skin from adjacent areas (flap), grafting skin
removed from another site, or allowing it to heal by itself
without suturing. The wound size and location determine the
type of repair performed.
Common risks of the procedure include pain, bleeding,
infection, scarring, numbness and nerve damage, and the risk
of recurrence. Ice and Tylenol are the first step for pain
control after surgery. The risks of bleeding and infection are
approximately one to two percent, but can be minimized with careful
post-operative care. While Mohs surgery guarantees the highest cure
rates, no technique offers a 100 percent chance of a cure. There is a
small chance, at least one to two percent, depending on tumor type and
location, that the skin cancer will recur.
Anytime the skin is cut, a scar will develop. All steps are taken
to minimize the cosmetic and functional significance of any
scars. It is important to remember that complete healing of the
scar takes place over 6-12 months. The surgery site may feel
swollen, “lumpy”, and there may be redness for the first few
months after surgery. This is part of the normal healing
process.
What are the
benefits of Mohs surgery?
Mohs surgery offers the highest cure rate for nonmelanoma skin cancers, usually greater than 95 percent. This is due to the more careful evaluation of the tissues. Additionally, less healthy tissue is removed during Mohs surgery, than during a routine excision. This offers an added advantage for removing tissue in delicate areas of the nose, eyelid, ears and lips. In addition, Mohs surgery
is offered in an office setting with local anesthesia for added safety and cost effectiveness.
If Mohs surgery has the best cure rate for nonmelanoma skin
cancer, why aren't all skin cancers removed with Mohs surgery?
There are multiple treatments available for skin cancers,
including electrodessication and curettage (burning and scraping), laser,
excision, radiation, interferon and topical 5-fluorouracil. Your skin
specialist can assist you in the selection of the optimum treatment. Each situation is different, but with proper
selection, cure rates of 90-93 percent with the above techniques are expected. The key
is proper selection.
Who are candidates for Mohs surgery?
Mohs surgery should be considered in basal
cell and squamous cell carcinoma at risk for recurrence. These factors are well known and are based on past history,
type of basal cell carcinoma and location. Recurrent tumors, tumors in the
"T" or "H" zone (midface and ears), large tumors (greater than 2 cm) are all
candidates for Mohs surgery. In addition, certain basal cell carcinomas
such as morpheaform, infiltrating, micornodular, adenoid and multifocal tumors
are more likely to recur and thus are candidates for Mohs surgery. Squamous cell carcinomas can also be addressed well. With Mohs surgery some
rare tumors such as dermatofibrosarcoma protuberans, microcystic adenexal carcinoma
are successfully treated with Mohs surgery. We also use a modified Mohs surgery on early
melanoma in selected cases.
As you can see, the decision for Mohs surgery
verses alternative
therapies is complex. Your skin specialist can assist
you in the evaluation of your lesion, including biopsy, and help you decide if Mohs is appropriate for you.
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