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We offer the following skin care lines in our two offices:
Skin Medica Skin Care
Epionce Skin Care
Nu Cell Skin Care
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Elta MD Sunscreen
Cutemol Skin Lotion
Color Science Mineral Make up

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What is Mohs Surgery?

If your doctor has recommended Mohs micrographic surgery as treatment for skin cancer, it is because this state-of-the-art procedure offers the highest cure rate and reduces scarring disfigurement. The most common skin cancers treated by Mohs surgery are basal cell carcinoma and squamous cell carcinoma, however, several other less common skin cancers are also treated with this method. 

Mohs surgery cure rates 

Are 99% for treatment of basal cell carcinoma and 97% for squamous cell carcinoma--the highest of all cure rates for skin cancer.  

Qualifications of the Mohs Surgeon

A fellowship-trained Mohs surgeon is a board-certified dermatologist with extensive training in cancer surgery, pathology and reconstructive surgery.  The higher cure rates achieved through the Mohs procedure are a result of the surgeon’s ability to examine 100 percent of the surgical tissue margin under the microscope on the day of surgery. 

The Surgery

Skin tumors are removed one layer at a time and frozen sections are examined under the microscope immediately after they are removed. Using the microscope, the Mohs surgeon can see which way the tumor is growing.  Often, these tumors grow like roots of a tree, extending farther under normal-looking skin than what you see with the naked eye.
 
While the patient relaxes in the waiting room, the tissue is examined.  The frozen section tissue processing and microscopic examination of the lesion between stages requires 45 minutes to an hour.  During this time, the patient will be allowed to sit in the waiting room with friends or family.  We recommend bringing ample reading material (books, magazines, laptop computer, etc.). We provide a quiet, peaceful environment with beverages such as coffee, tea and water, plus light snacks, and also suggest that you bring healthy snacks and perhaps a  sack lunch.
 
The patient reenters the treatment room and additional tissue is removed only in the area where the margin was positive. Most cases are cleared in one to three stages; however, larger or recurrent tumors often require multiple stages.  The tumor removal and reconstructive surgery typically occurs in a single day, requiring approximately three to five hours from beginning to end.  If the patient is scheduled for an 7:30 am appointment, they should plan to be in the clinic until approximately 10:30 am to 12:30 pm.  
 
Occasionally, complex cases require more time and/or delayed reconstructive repairs.  In such cases, Dr. Robbins will meet with you to discuss these issues and answer any questions or concerns.

Reconstruction

The Mohs surgeon has extensive training in reconstructive procedures and often performs the wound closure after the tumor is removed.  A small wound may be allowed to heal on its own, or the wound may be closed with stitches, a skin graft or a flap.  Since Mohs surgery preserves the maximum amount of normal skin, this results in smaller scars.   
Almost all surgical defects are repaired by Dr. Robbins immediately after removal of the skin cancer.  If your surgery becomes extensive, or involves a sensitive functional area, an appointment with a subspecialty reconstructive surgeon will be arranged for the repair of the surgical defect.  Every effort will be made to anticipate these more complex situations. 
A consultation with Dr. Robbins may be necessary prior to the Mohs surgery day.  If you would like to meet with Dr. Robbins prior to your surgery appointment, she would be happy to schedule a consultation visit. 

Patient Preparation for Surgery

Continue to take your regular medications at the times you routinely take them. However, if you take aspirin, vitamin E, or fish oil for prevention only (not medically advised to do so) please stop these 1 week prior to surgery. If you take ibuprofen/advil/motrin, etc. for pain, please refrain from taking them one week prior to surgery. Please inform your Mohs surgeon if you are medically required to take these or any prescription blood thinning medications. Blood thinners can lead to increased bleeding, swelling and bruising following surgery. 

Please get a good night’s rest and eat normally prior to your surgery. Shower the morning of your surgery with antibacterial soap and do not wear makeup. 

We recommend that you wear comfortable clothing and an extra layer for warmth.  Please wear a shirt that can be removed without pulling it over your head (i.e. one with buttons or zippers down the front).  A book, magazine, or laptop computer may be helpful during the waiting periods of the day.

Also, you may want to arrange for a friend or family member to drive you home after your surgery. 

Medications during and after Surgery

A patient may be given antibiotics on the day of surgery and for a short period post-operatively.  Pain after surgery is generally described by patients as “throbbing” or like a “deep bruise” but is not typically sharp in nature.  Surgery on the forehead or scalp may trigger headaches on the first night or first few days of recovery.  Over-the-counter and/or prescription pain medications may be necessary and will be discussed on the day of surgery.

About Dr. Robbins

Originally from southern California, Dr. Robbins earned her medical degree from the University of Nevada, School of Medicine in Reno where she was elected to the prestigious Alpha Omega Alpha Honor Medical Society.  Dr. Robbins completed a preliminary medicine internship at University of Nevada in Las Vegas, and her residency training in dermatology at Baylor College of Medicine in Houston where she also served as their chief resident. 
She went on to become faculty at Baylor College of Medicine before completing her fellowship in Procedural Dermatology at Baylor College of Medicine. 

Most recently, Dr. Robbins founded and headed a Mohs and dermatologic surgery department in a private practice office before relocating to Gig Harbor.  She has authored more than  40 publications, including two book chapters, and has been asked to present material at several national meetings.  

Dr. Robbins primarily practices dermatologic surgery, including Mohs micrographic surgery and cosmetic procedure. She is a member of the American Academy of Dermatology, the American College of Mohs Surgery, and the American Society for Dermatologic Surgery.  
 
To learn more about Mohs Surgery and Dr. Robbins, please download our Mohs Surgery Brochure:
 
 


Questions?
 
If you have further questions about the Mohs procedure you may contact Peninsula Dermatology and Laser Center at (253) 851-7733.  You may also contact the American College of Mohs Micrographic Surgery and Cutaneous Oncology at (800) 500-7224 or info@mohscollege.org.