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San Ramon, CA 94583

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“Our goal is to blend state-of-the-art medical technology with a staff dedicated to patient welfare and healing and to provide our patients with the best possible dermatologic surgery care. Our patients expect the best from us, and we strive to meet and exceed these expectations.”

IMG_Columbia 2The Gladstone Clinicoffers Mohs Micrographic Surgery. Mohs skin cancer surgery is used to treat the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma. It currently offers the highest cure rate for primary and recurrent nonmelanoma skin cancer. It is considered the gold standard. This technique is also used for less common skin cancers.

What is Mohs surgery?

Mohs micrographic surgery is an advanced and highly specialized technique for the removal of skin cancer. The procedure was developed by Dr. Fredrick Mohs at the University of Wisconsin back in the 1930s and now it is practiced throughout the world. It offers the highest potential for recovery; the cure rate can be up to 99 percent, even if other treatments have failed. The reason that mohs surgery is indicated for many skin cancers is because they have “roots” and can spread beyond what we can see.
*Results may vary from person to person

Why is Mohs surgery different?

Mohs surgery permits the immediate and complete microscopic examination of all the marginsof the removed cancerous tissue. The mohs surgeon is specifically trained to interpret the tissue under a microscope. The definition of a mohs surgery is that the skin is removed and examined under a microscope by the same specialist. Careful examination ensures that all of the cancerous tissue is eliminated. Mohs surgery removes only the cancerous tissue and spares the normal tissue.
*Results may vary from person to person

The Procedure

The procedure is performed in the comfortable setting of the Gladstone Clinic. Your biopsy site is identified, then marked and numbed up similar to your skin biopsy. After a few minutes, Dr. Gladstone removes a small piece of skin—a minimum of normal skin is removed. This is particularly important in cosmetic-sensitive areas such as the face. A bandage is placed..Dr Gladstone takes your skin to his lab in the office where it is cut and stained. He methodically and precisely maps the location of the tumor. This process takes about 25-30 minutes, and patients can either stay in the exam room or go to the waiting room and read or eat.Dr Gladstone strives to perform Mohs as accurately and expeditiously as possible, but the mohs surgery and the reconstruction performed by Dr Gladstone may take 4-5 hours depending on the size of the tumor and complexity of the defect.
If there is still skin cancer, then Dr Gladstone will renumb the area, and again take a small piece of skin based on his precise microscopic mapping. This continues until there is no more skin cancer.
*Results may vary from person to person

Why have your Mohs surgery done at the Gladstone Clinic?

Dr Gladstone completed a year longsurgery fellowship accredited by the American College of Mohs Surgery. It was a highly selective fellowship in mohs surgery and reconstruction. Previous to that training he completed a residency in Dermatology and trained in Otolaryngology-Head and Neck Surgery. Prior to medical school, he was a professional photographer. From 2000-2011, Dr Gladstone was the Director of the Division of DermatolgoicSuergery and head of mohs surgery at Stanford Unviersity. He has lectured nationally and internationally on Mohs surgery and published many articles. This background provides Dr. Gladstone with the skills and vision to perform Mohs surgery at the highest level.
*Results may vary from person to person

Mohs Surgery: Illustrated

A typical Mohs surgery procedure is illustrated in the following diagrams:

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Figure 1– The area to be treated is cleansed, marked, and injected with a local anesthetic. The Mohs surgeon removes the visible cancer, along with a thin layer of additional tissue. This procedure takes only a few minutes, and the patient waits while the tissue is processed and examined.

Figure 2 – Tissue cut in a saucer shape. The removed tissue specimen is cut into sections, stained, and marked on a detailed diagram called a Mohs map.

Figure 3 – The tissue is frozen on a cryostat, and a technician removes very thin slices from the entire edge and undersurface. These slices are then placed on slides and stained for examination under a microscope. This is the most time-consuming portion of the procedure, often requiring an hour or more to complete.

Figure 4 – The Mohs surgeon carefully examines the entire undersurface and compete edge of the specimen, and all microscopic “roots” of the cancer are precisely identified and pinpointed on the Mohs map. Upon microscopic examination, if residual cancer is found, the Mohs surgeon utilizes the Mohs map to direct the removal of additional tissue (Figure 2). Note that additional tissue is removed only where cancer is present.

Figure 5 – This process is repeated as many times as necessary to locate any remaining cancerous areas within the tissue specimen (Figure 3, Figure 4, etc.)

Figure 6 – When microscopic examination reveals that there is no remaining tumor, the surgical defect is ready for repair.