Medical Dermatology San Diego, CA

Surgical Dermatology

Dr. Swati Kannan is a board-certified and fellowship trained Mohs surgeon, meaning she did an extra year of training focusing on surgical excision of skin cancers and reconstruction of excised defect. She has performed over 3000 surgeries and has given several lectures within this field. Whenever you’re looking for a Mohs surgeon, make sure your surgeon is fellowship-trained.

She also performs surgeries for benign lesions like lipomas, cysts and moles.

Skin Cancer

There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. Each of these skin cancers is primarily caused by too much exposure to the sun, but genetics may also play a role in increasing your risk for skin cancer.

Skin diseases and cancers are most effectively diagnosed through a biopsy that can be performed in our office and sent to a specialist or lab.

Once you receive a skin cancer diagnosis, the type of treatment will depend on the type of cancer, size, depth, location and your preferences. All the treatments can be performed in Dr. Kannan’s office under local anesthesia.

Typical treatments for skin cancers include Mohs surgery, excisions, electrodessication and curettage, application of chemo cream or laser. The modality of treatment is based on location, type and size of tumor. The best options are discussed with the patient prior to proceeding with the treatment.

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Mohs Micrographic Surgery

Mohs surgery is named after the inventor of the procedure, Frederic Mohs. It is a special form of surgery in which the surgeon cuts out the skin cancer, reviews the pathology under the microscope and performs the reconstruction. The goal of Mohs surgery is to remove the least amount of normal skin while still cutting out the entire skin cancer.

Mohs surgery is recommended when:

-the skin cancer is located on the face, hands, feet or areas of the body where large margins cannot be initially excised

-the skin cancer is aggressive

-the extent of the tumor is difficult to determine

The procedure is done completely under local anesthesia. Dr. Kannan removes thin layers of the skin involving the tumor. Each layer is processed while you wait. Once it’s processed, Dr. Kannan examines the tissue under the microscope to determine if any cancer cells remain. This process is repeated under the tissue margins are free of cancer cells. Once the margins are clear, Dr. Kannan will then perform the reconstruction to close the wound. This reconstruction can often be more complex than the patient anticipates. While Mohs surgery can take many hours, it provides the highest cure rate of 99% for skin cancers and results in preservation of normal skin.

While any dermatologist or physician can claim to perform Mohs, it is important to see a fellowship-trained Mohs surgeon due to the complexity of the procedure.

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An excision is when the tumor, along with a margin of normal skin (or benign lesion with no margins), is removed using a scalpel. The wound is then repaired using sutures (stitches). All excisions are performed under local anesthesia. The excised tissue is then sent to a pathologist to ensure the margins are clear of cancer cells or to confirm the clinical diagnosis.

For skin cancer, cure rates after excisions are around 95-97%. Excisions can be performed for skin cancers on the trunk and extremities if under a certain size, and this procedure is faster than Mohs surgery.

Dr. Kannan also performs excisions for benign lesions like cysts, lipomas or other skin growths.

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Electrodessication and Curettage (EDC)

EDC is a good treatment for small and superficial skin cancers like basal cell or squamous cell carcinomas. After injection of local anesthetic, the tumor is scraped off, and the base is burnt with electrocautery. It leaves a circular white scar slightly larger than the size of the lesion. The cure rate is around 90% for superficial skin cancers.

We also use like EDC for benign growths like seborrheic keratosis (the warty brown spots that occur from aging), flat skin tags, certain growths on the face similar to keratoses or overgrowth of oil glands. This is usually cosmetic and not covered by your insurance.

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