Skin cancer is a group of incredibly common and potentially dangerous diseases. While early detection is always best, even advanced cases often have excellent treatment options.
One of the most well-known options is Mohs surgery, but many don't realize plastic surgeons are bringing revolutionary new techniques and unmatched expertise to skin cancer removal and reconstruction. We'll discuss this, with a focus on Dr. Andrew Ress, a leading plastic surgeon in Boca Raton, Florida, who's developed the [liv]® PDEMA technique.
The American Cancer Society describes Mohs as a subset of PDEMA
”Mohs surgery is the most common type of micrographic technique (sometimes called peripheral and deep en face margin assessment or PDEMA), but there are others. Other techniques might differ slightly in how the surgery is done, how the tumor samples are processed, or how long the procedure might take. But they all allow the surgeon to check the edges (margins) of the removed tumor sample and then remove more layers of tissue if needed.[1]”
What is Mohs Surgery?
Mohs micrographic surgery is an established method for skin cancer removal [2]. In this procedure, a dermatologist removes a thin layer of skin, examines it under a microscope, and continues removing layers until no cancer cells remain. Specifically it requires the entire outside surface of the specimen to be examined completely. This approach boasts impressive cure rates, especially for cancers in sensitive areas like the face. For billing purposes Mohs requires the surgeon to also perform the pathology [3].
Why Consider a Plastic Surgeon for Skin Cancer Removal?
While Mohs surgery is excellent, it has limitations. Here's why plastic surgeons often hold an advantage:
- Reconstruction Expertise: After the cancer is removed, the wound (also called the defect) needs closing. Plastic surgeons are the masters of reconstruction, ensuring both optimal healing and the best possible cosmetic outcome. This is vital in areas like the face, where function and appearance are major concerns [4].
- Complex Cases: When cancers are large, aggressive, or affect underlying structures, plastic surgeons have the broad skillset to manage them safely and achieve the best result.
- Patient-Focused Team Approach: Plastic surgeons understand the deep emotional and aesthetic impact of skin cancer. They prioritize patient comfort, personalized treatment plans and open communication including with other treatment providers such as oncologists [5].
- Hospital Privileges: Office based procedure and on staff at local hospital required so no change of doctor required.
Introducing Dr. Andrew Ress and [liv]® PDEMA
Dr. Andrew Ress of Boca Raton has refined skin cancer treatment with his [liv]® PDEMA technique. PDEMA stands for Peripheral and Deep En Face Margin Assessment which he has performed since 2005 in his Boca Raton offices.
PDEMA = Mohs but with the (plastic) surgeon and surgical pathologist working together as a team. PDEMA results are proven equivalent to Mohs [6].
This approach blends the precision of Mohs surgery with added benefits:
- Real-Time Analysis: During [liv]® PDEMA, the removed tissue is immediately examined using frozen section technology for cancer cells. This provides real-time results, guiding the surgeon with exceptional accuracy
- Maximal Tissue Preservation: Because the presence of cancer cells can be determined on the spot, [liv]® PDEMA often allows for less healthy tissue to be removed, aiding healing [7].
- Comprehensive Results: As well as removing the cancer, [liv]® PDEMA creates a detailed map of the excised tissue. This aids further treatment if needed and provides a vital reference for ongoing skin checks.
- Second Double Check in the main lab to confirm the results
- Specimens preserved: for 7 years. Can look back to check results anytime
Additional Benefits of [liv]® PDEMA
Dr. Ress' technique builds upon Mohs, offering these additional benefits:
- Equal or Higher Success Rates: The real-time analysis potentially increases the likelihood of complete cancer removal in the initial surgery
- Reduced Scarring: The focus on healthy tissue preservation and precise stitching only a skilled plastic surgeon can perform will minimize the size and prominence of any scars. Scar minimization is a key component of Plastic Surgery
- No Travel Between Offices: We offer a one stop location so you don’t need to run around town with big bandages to find a reconstructive surgeon.
- Direct Text Dr Ress: Our doctors provide their cell phone numbers so you can text any time to ensure all is going well
- Faster Recovery: Less tissue removal may translate to faster healing times
- Peace of Mind: with nearly 30 years’ experience and trained at some of America’s top medical centers, Dr. Ress is a master of his craft.
- Covered by Insurance: Skin cancers are normally covered as medically necessary services. No insurance? Dr. Ress will charge you the Medicare allowed rate- a senior discount even if you are not so senior [8].
Regular skin self-checks are vital (your dermatologist can offer guidance). If you notice changes, early diagnosis is key!
[liv]® PDEMA and Dr. Andrew Ress: The Next Level in Skin Cancer Care
While Mohs is an effective treatment, plastic surgeons like Dr. Ress are pushing the boundaries of skin cancer care. [liv]® PDEMA offers a technological edge, potentially improving success rates, minimizing scarring, and maximizing patient comfort. If you have a skin cancer concern in Boca Raton, seeking expertise from a skilled plastic surgeon specializing in skin cancer removal is a wise investment.
Skin cancer is serious, but treatment options are continually improving. Plastic surgeons are at the forefront of this advancement, and techniques like [liv]® PDEMA hold the promise of even better outcomes. If you're facing skin cancer, considering the expertise of a plastic surgeon could make all the difference.
A REAL PATIENT STORY:
"My experience was a 10/10 with Dr. Ress and his team. They made me feel safe and comfortable through the entire procedure. They made sure I experienced little to no pain at all. I will definitely be coming back to use Dr. Ress and his team again."
Review from RealSelf.com
REFERENCES
- Surgery for Basal and Squamous Cell Skin Cancers. In: American Cancer Society [Internet]. Available: https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/treating/surgery.html
- Wong E, Axibal E, Brown M. Mohs Micrographic Surgery. Facial Plast Surg Clin North Am. 2019;27: 15–34. doi:10.1016/j.fsc.2018.08.002
- Centers For Medicare and Medicaid. Billing and Coding: Mohs Micrographic Surgery. Available: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57477
- Bouhadana G, Aljerian A, Thibaudeau S. The Reconstruction of Plastic Surgery: A Historical Perspective on the Etymology of Plastic and Reconstructive Surgery. Plast Surg (Oakv). 2023;31: 366–370. doi:10.1177/22925503211064377
- Combining expertise with innovation - Multimodality skin cancer treatment at Lynn Cancer Institute. Available: https://physicianresources.baptisthealth.net/news/combining-expertise-with-innovation-multimodality-skin-cancer-treatment-at-lynn-cancer-institute
- Stevens JS, Murad F, Smile TD, O’Connor DM, Ilori E, Koyfman S, et al. Validation of the 2022 National Comprehensive Cancer Network Risk Stratification for Cutaneous Squamous Cell Carcinoma. JAMA Dermatol. 2023;159: 728–735. doi:10.1001/jamadermatol.2023.1353
- Kibbi N, Petric UB, El-Banna G, Beaulieu DM, Rajan N, Srivastava D, et al. Clinical Outcomes in Sebaceous Carcinoma: A Retrospective Two-Center Cohort Study. Dermatol Surg. 2023;49: 1122–1127. doi:10.1097/DSS.0000000000004016
- Does Insurance Cover Plastic Surgery After Skin Cancer? Available: https://www.coveringcfl.net/does-insurance-cover-plastic-surgery-after-skin-cancer/
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