For many people, the thought of undergoing surgery is terrifying – so, My City Wellness “scrubbed in” to get up close with two talented local physicians as they performed state-of-the-art procedures. Our sincere thanks to doctors Bishr Al Dabagh, MD, FAAD and Marc Silver, MD for their gracious cooperation in creating this special section.
Bishir Al Dabagh MD, FAAD
PROCEDURE/SURGERY: Mohs Micrographic Surgery
CREDENTIALS: A board-certified dermatologist and a fellowship-trained Mohs surgeon focusing on the treatment of skin cancers, he graduated with Honors from the University of Michigan-Flint, attended medical school at Case Western Reserve University. He then trained in dermatology at Duke University and finished a Procedural Dermatology fellowship at the University of California – San Francisco.
FACILITY: Michigan Dermatology
METHOD/DESCRIPTION: This is a highly-specialized technique focusing on the accurate removal of skin cancer with margin control, while at the same time sparing the greatest amount of healthy tissue. This is accomplished by a special method of cutting the skin cancer out and then processing the tissue in a lab in the office using a unique frozen section technique while the patient waits. The surgeon reads the slides to ensure the entire cancer is removed; if not, another cut is performed (on the same day) and the tissue is tested again. The procedure is repeated until all the cancer has been removed.
The surgeon then performs reconstruction of the defect. It is an all-in-one: surgical removal, pathology and reconstruction. There is no need to go to a surgical center or hospital and the patient can go home on the same day.
This surgery is very innovative because the surgeon is also the pathologist and checks 100 percent of the margin (all the peripheral and deep margin), whereas standard excision procedures need at least two doctors (surgeon and pathologist, and in some cases, anesthesiologist) and only samples the margins instead of checking 100 percent of it. Mohs surgery has the highest cure rate of any other modality (excision, radiation, creams, curettage), with cure rates of 99 percent for primary basal cell and squamous cell carcinomas. Dr. Al Dabagh has performed this surgery 3,500 times.
The surgery is done under local anesthetic only, making it a very safe and well-tolerated procedure. The patient is awake during surgery and does not need to fast the day before. After surgery, the patient should not engage in exercise or arduous activity. They should follow their wound care instructions and follow-up with the surgeon for wound check and suture removal. Not all skin cancers are appropriate for Mohs surgery. The type, location, size and patient factors are all important.
Article Source: MyCityMag.com