Mohs Micrographic Surgery
Mohs Micrographic Surgery is available in Santa Barbara at the Dermatologist and Dermasurgeon office of Keith Llewellyn MD (Aloe Dermatology.)
Mohs micrographic surgery is an advanced and highly specialized technique to remove skin cancer and is performed by Santa Barbara based dermatologist and dermasurgeon Keith Llewellyn MD. It offers the highest potential cure rates for skin cancer while preserving as much normal tissue as possible. This surgical technique was originally developed by Dr. Frederic Mohs in the 1930's and over the years has become even more refined. Mohs surgeons are skilled not only in Mohs surgery, but also dermatology, dermatopathology, dermatologic surgery and reconstructive surgery.
Mohs surgery is performed in Dr. Keith Llewellyn's Santa Barbara dermatologist office as an outpatient surgical procedure. Local anesthesia is used so the patient is awake and comfortable during the procedure. The visible margins of the skin cancer are outlined with ink and then the skin cancer is removed with a very small safety margin of what appears to be clinically normal skin. A bandage is placed on the patient who then relaxes in the waiting room while the tissue is immediately processed in the office. The cancerous tissue that is removed is processed by a highly trained histopathologist and then examined by the Mohs surgeon, Keith Llewellyn MD, while you are waiting. The tissue is processed in a manner that allows for visualization of nearly 100% of the true margins of the surgical specimen. Additionally, the tissue and the patient are marked like a map or clock with ink and carefully placed surgical nicks. If the Mohs surgeon, Keith Llewellyn MD, looks under the microscope and sees that the skin cancer is present around the 3 o'clock margin, the patient will be brought back to the surgical suite again for the removal of an additional small arc of tissue around the 3 o'clock area. In this example, the Mohs surgeon does not make the whole hole deeper or remove another full circle of tissue. The Mohs surgeon, guided by the microscopic examination of the tissue and careful mapping of the skin cancer, removes only the tissue that is affected by skin cancer and strives to preserve as much normal skin as possible. This next piece of tissue is processed and mapped in a similar manner. Keith Llewellyn MD, your Mohs surgeon, will repeat this process (called "stages") until the roots of the skin cancer have been completely removed and the margins of the removed skin tissue appear normal under the microscope.
Mohs surgery is an advanced, precise surgical technique that offers the highest possible cure rate for skin cancer while also preserving normal tissue. It is, however, time consuming. Dermatologist and Dermasurgeon Keith Llewellyn MD advises his patients to plan to be in his Santa Barbara office from the morning to the early afternoon. Obviously, if your skin cancer is removed with the first one or two stages, you will be going home more quickly. The average time duration of Mohs surgery for Dr. Keith Llewellyn's patients is about 3 hours. Each skin cancer in a given individual, however, is unpredictable. Sometimes, the skin cancer that you see on the surface of the skin represents the full extent of the tumor. In these cases, it is fully removed on the first stage of Mohs surgery. Other times, the skin cancer you see on the surface of the skin may represent the tip of an iceberg and it has roots under the skin that extend far from the clinically visible skin cancer. In these cases, it may take several stages to remove the skin cancer. Most of your time during Mohs surgery is spent comfortably awaiting the results of your tissue processing in the waiting room (this typically takes 30-40 minutes per stage). As you will be in Dr. Keith Llewellyn's office for some time, eat a good breakfast, bring snacks and a good book. Aloe Dermatology also provides Wi-Fi, so you could bring your lap top and surf the web as well.
Once the skin cancer is removed, a defect will be present. Keith Llewellyn MD repairs most of these defects the same day as your Mohs surgery in his Santa Barbara office. Usually the defect can be closed in a straight line, but skin flaps or skin grafts may need to be performed by Dr. Keith Llewellyn to attain a superior cosmetic and functional repair. Stitches are usually in place for one week and then removed. Occasionally, in particularly challenging or large defects, Dr. Keith Llewellyn may enlist the help of a Santa Barbara plastic surgeon to repair the defect created by removal of your skin cancer. This is usually arranged ahead of time so that your surgical repair can be done the same day as your Mohs surgery.
Mohs surgery is not performed on every skin cancer. It is typically reserved for skin cancers on cosmetically sensitive areas (i.e. face, ears, nose, lip) and areas where tissue preservation is of functional importance (fingers for instance). Mohs surgery is also used for recurrent skin cancers, skin cancers incompletely removed by a previous excision, large skin cancers, skin cancers with poorly defined clinical borders, skin cancers in certain high risk anatomic areas and aggressive skin cancers.
Not too long ago, Mohs micrographic surgery was only available to patients in large university settings. Today, dermatologist and dermasurgeon Keith Llewellyn MD can perform Mohs micrographic surgery on your skin cancer right here in Santa Barbara in a pleasant, nearby outpatient setting.
Note: This information is not intended to render medical advice on a particular case. To receive medical advice requires a visit with a medical physician. Keith Llewellyn MD in Santa Barbara is certified to the highest national standards to detect and treat skin cancer by the American Board of Dermatology. He is a fellow of the the American Society for Mohs Surgery, the American Society for Dermatologic Surgery, the American Academy of Dermatology and the Skin Cancer Foundation.