Surgical Dermatology

Prior to most dermatologic surgery, a biopsy of the lesion is performed. Three methods used include:

  • Shave biopsy
  • Excision
  • Curettage or scraping

Once the tissue is available, it is placed under a microscope and studied by experts in pathology. Drs. Richey and Vannucci are both Board Certified Histopathologists. Dr. Sajben is also an expert in pathology. If indicated, the tissue specimens are sent to the Melanoma Center at the University of California San Francisco for a second opinion.

Dermatologic surgery is almost always performed in a medical office. Local anesthetic is used. Minimal to no discomfort will be experienced during and after the procedure.

There are various methods of performing dermatologic surgery, including:

Surgical excision followed by wound closure using one of the following techniques:

  • Simple or intermediate closure with sutures
  • Grafts or flaps if the wound is more extensive

Curettage and electrodessication

  • A sharp instrument called a curette is used to scrape away the malignant tissue.
  • An electrosurgical unit is used to stop bleeding and burn away additional tissue.
  • Wound healing is by secondary intention, meaning it is not closed with sutures.

Cryosurgery

Liquid nitrogen is sprayed on the lesion, freezing and destroying the malignant tissue. Healing will occur with minimal scarring

Mohs Surgery

Mohs surgery is microscopically controlled surgery used to treat common types of skin cancer. This procedure is essentially a pathology sectioning method that allows for complete examination of the surgical margins. This procedure is highly used in tumors that have poorly defined margins and need the microscope examination done at the time of surgery. Mohs can last from 30 minutes to several hours depending on the size and the depth of the tumor.

The procedures described above are used for the following skin conditions:

  • Skin cancers
  • Benign lesions such as cysts, moles, actinic keratoses, seborrheic keratoses, warts