Bravia Skin Cancer Institute

 

Bravia Dermatology is committed to skin cancer prevention and management.  We see it as the most important thing that we do.

For surgical management of skin cancer, Dr. Molenda treats skin cancers with Mohs surgery, Excisions, Cryosurgery, and other local methods.  

Dr. Molenda has extensive experience in skin cancer management and reconstructive surgery, especially for the face.  Most reconstruction happens the same day in the office, all under local anesthesia.  In less common cases, general anesthesia or coordination with another surgeon may be necessary.    

 

 
 
Scheduled for Mohs Surgery? Be prepared with our Mohs Surgery Patient Checklist, and see our How To Prepare section.
Mohs Surgery Patient Checklist for Bravia Dermatology
 

What are the benefits of office-based skin surgeries?

  • Office based surgeries done under local anesthesia has been shown to be safer than surgeries done under general anesthesia.  The risks associated with general anesthesia include nausea, vomiting, teeth damage, and rarely death.1
  • Office based surgery is significantly less expensive than surgery in the operating room.  In some cases, a skin cancer removal (even without 100% margin control) and reconstruction done in the operating room can be more than 40 times (40x) more expensive.2 This is especially important to consider in uninsured patients and those who have a high deductible or percentage-based insurance plans.
  • Patients can eat and drink as normal.  Fasting is not necessary, and patients can take their regularly scheduled medication.
  • Patients typically do not need pre-operative clearance from another doctor.
  • Patients do not need to stop prescribed blood thinners like Aspirin, Coumadin, or Plavix.  (We do ask that your INR be less than 3).  In general, bleeding complications are easier to handle than a heart attack or stroke.
  • Patients are often surprised at how comfortable they can be with local anesthesia.
  • Patients can usually drive themselves home unless we are working near their eye, ear, hand, or foot; or if they require some optional medication to help them relax (rarely needed, but driver is required if administered). 
  • At our Toledo Office, patient-administered, inhaled nitrous oxide (laughing gas) can be optionally added on to any procedure to reduce anxiety and discomfort.    

References:
1. Starling J 3rd, Thosani MK, Coldiron BM. Determining the safety of office-based surgery: what 10 years of Florida data and 6 years of Alabama data reveal. Dermatol Surg. 2012 Feb;38(2):171-7.
2. Cook JL. "The reconstruction of two large full-thickness wounds of the upper lip with different operative techniques: when possible, a local flap repair is preferable to reconstruction with free tissue transfer." Dermatol Surg. 2013 Feb;39(2):281-9. 

Dr. Molenda - Fellowship Trained Mohs and Reconstructive Surgeon

Dr. Matthew Molenda - Top Doc, Top Toledo Mohs Surgeon

Dr. Matthew Molenda has specialized training in Mohs Micrographic Surgery which includes the removal, mapping, pathology, and reconstruction of skin cancer.  Patients with basal cell and squamous cell carcinoma on the head and neck (including scalp, ears, face, eyelids, nose, cheeks, lips), hands, feet, shins, genitals, and other sensitive areas are good candidates for Mohs Micrographic Surgery.   Additionally, this procedure is used on large or aggressive skin cancers on the trunk, arms, and legs.


Click here for an article from the Toledo Blade.  Publish date: Jan 20, 2014


Some benefits of Mohs surgery when compared to conventional excision are:

  • Tissue Sparing - Mohs surgery is tissue sparing, allowing preservation of as much normal skin as possible.
  • 100% margin check - Mohs surgery checks 100% of the margin for residual skin cancer; whereas traditional excision (such as those done in the operating room by Plastic Surgery) checks <1% of the true margin.  This is because of the unique way Mohs specimens are mapped and processed.
  • Highest Cure Rate - Mohs surgery has the highest cure rate available for non-melanoma skin cancers such as basal cell and squamous cell carcinoma.
  • Smallest Scars - Mohs surgery creates smaller surgical wounds, allowing for smaller reconstructions. Smaller repairs have less complications and usually have better cosmetic and functional outcomes.
  • Same Day Cure - Reconstruction of the surgery site often commences on the same day with a definitive cure.
  • Less risk of needing repeat surgery - Mohs surgery minimizes the need for repeat surgeries on different days because of positive margins found on tissue that is sent out for pathology.
  Dr. Molenda checks ~100% of the margin to make sure all the cancer is out.

 

Dr. Molenda is a fellow of the American College of Mohs Surgery
 

Dr. Molenda completed his residency in Dermatology at The Ohio State University Medical Center.  Afterwards, he completed a Procedural Dermatology fellowship at the Cleveland Clinic Dermatology and Plastic Surgery Institute with comprehensive training in Mohs and Reconstructive Surgery, Cosmetic Surgery, and Laser Surgery.  He is an associate Member of the American College for Mohs Surgery, which is an organization reserved for physicians who are fellowship-trained in this procedure.  

Reconstruction after Skin Cancer Removal

Surgical wound on nose before closure, and 1 week later before and after sutures removed.

Reconstruction Frequently Asked Questions:

1.  Do I need to see a plastic surgeon for reconstruction?

No, not usually.  In fact, fellowship-trained dermatologic surgeons spend 1-2 years after their residency (which also includes comprehensive surgical training) focusing on skin surgery and reconstruction.  Generally, this additional focused surgical training results in more training in skin repair than any other specialty. 

Dermatologic surgeons do complex reconstruction of facial wounds, skin flaps, and skin grafts.  The vast majority of these procedures are done under local anesthesia in the office setting.  Occasionally, a plastic surgeon, oculoplastic surgeon, otolaryngologist, or surgical oncologist will be coordinated with for the repair of larger wounds based on patient and physician preference.

However, if you prefer to see another surgeon for your reconstruction, we can refer you to some excellent ones.

Dr. Molenda is a fellowship trained dermatologic surgeon.  To find other fellowship trained dermatologic surgeons, please visit: http://acms.execinc.com/edibo/SurgeonFinder

2. What is the difference between a dermatologic surgeon and a plastic surgeon?

Plastic surgeons typically deal with repairing trauma repair and larger surgeries that require general anesthesia (e.g. breast reconstruction, breast implants).  Some even do bone repairs such as hand trauma.

Dermatologic surgeons, on the other hand, typically perform their surgeries under local anesthesia, often in an office setting.  Local anesthesia has many advantages for patients because it is safer, less expensive, does not require fasting, and does not carry the risks associated with general anesthesia.  Fortunately, nearly all non-melanoma skin cancers (basal cell carcinoma, squamous cell carcinoma) can be removed and reconstructed safely in an office-based setting by a dermatologic surgeon.  

 

Comparison Between Mohs and Standard Excision

Mohs tissue processing allows for complete 100% margin evaluation. This results in smaller scars and a higher cure rate.
Mohs processing allows the surgeon to be tissue sparing while offering the highest cure rate available because virtually 100% of the margin is checked for cancerous cells.  The tissue sparing nature of the Mohs procedure results in a smaller scar and better cosmetic outcome.

 
Standard excisions are processed with vertical sections, which actually check less than 1% of the margin on average. This results in larger scars and a lower cure rate.
Standard Excisions are processed with vertical sections, resulting in lower cure rates and larger scars.  Less than 1% of the margin is checked on Standard Excisions processed with traditional methods.  Since Mohs checks virtually 100% of the margin, it is tissue sparing and has a higher cure rate.