Dr. Stephanie Clements
Board Certified in Dermatology
Dr. Stephanie Clements – a fellowship-trained Mohs surgeon, who attended the University of Maryland School of Medicine. She completed an Internal Medicine Internship at Mercy Medical Center in Baltimore and her dermatology residency at the University of Maryland, where she served as the Chief Resident. She completed her fellowship Micrographic Surgery and Dermatologic Oncology fellowship at the nationally-recognized Scripps Clinic in La Jolla, CA under Dr. Hugh Greenway, who trained with Dr. Frederic Mohs (the inventor of Mohs surgery). During her fellowship, she completed over 1,000 cases and was a part of a multidisciplinary team of specialists including Head and Neck Surgery, Plastic Surgery, Oncology, and Radiation Oncology. She is board certified in dermatology and an active member of the American Academy of Dermatology, American Society for Dermatologic Surgery, and the American College of Mohs Surgery.
FREQUENTLY ASKED QUESTIONS
What is Mohs Micrographic Surgery? Mohs Micrographic Surgery (MMS) or Mohs surgery, is a specialized treatment for the total removal of skin cancer. Mohs surgery is named in honor of Dr. Frederic Mohs, the physician who developed the technique. This method differs from all other methods of treating skin cancer by the use of complete microscopic examination of all of the tissues removed surgically as well as detailed mapping techniques to allow the surgeon to remove every cancer cell. The procedure is begun after the skin is injected with local anesthetic to completely numb the area. The visible cancer and a thin layer of skin are removed from that exact location, and may be repeated as often as necessary to completely remove the cancer.
What are the advantages of Mohs Micrographic Surgery? By using detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The result is (1) the highest possibility for curing the cancer, and (2) the removal of as little normal skin as possible.
What are my chances for cure? Using Mohs surgery, the percentage of cure is up to 99% for previously untreated skin cancers. Skin cancers that have recurred after prior treatment attempts have lower cure rates. Other methods of treatment offer only 50-80% chance of success if previous treatments have failed.
Will I be hospitalized? No. Mohs surgery is performed in an outpatient surgical suite and you may return home the same day.
What happens the day of surgery? Your appointment will be scheduled at our facility at 1849 Old Donation Parkway, in Virginia Beach. Our staff will escort you into the surgical suite where we will numb the area around the skin cancer. Once it is numb, the visible cancer and a thin surrounding layer of tissue will be removed. The tissue is carefully mapped and coded by the surgeon and taken to the adjacent laboratory where the technician will immediately process the microscope slides. You will have a temporary dressing placed over the wound and you will be free to return to the waiting room.
The surgical removal procedure takes approximately 15 minutes. However, it takes anywhere from 1-2 hours to prepare and microscopically examine the tissues of each layer. Several surgical stages and microscope examinations may be required, and you will be asked to wait between stages. Although there is no way to tell before surgery how many stages will be necessary, most cancers are removed in three stages or less. Surgical repairs take 30-90 minutes depending on wound size and location. The most difficult part of the procedure is waiting for the results of the surgery. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you plan to be at our clinic the entire day and make no other commitments. We would like to make your visit as pleasant and comfortable as possible. Plan on bringing a snack as
the day can be quite long. In general, it is a good idea to come to your appointment with a companion, someone who will be able to drive you home after the surgery.
Will the Surgery leave a scar? Yes, any form of treatment will leave a scar. However, because Mohs surgery removed as little normal skin as possible, scarring is minimized. Immediately after the cancer is removed, we may choose (1) to leave the wound to heal by itself, (2) to repair the wound with stitches, or (3) to reconstruct the wound with a skin graft or flap. The decision is based upon the safest method that will provide the best cosmetic result. Wounds, such as those involving eyelids, may be referred to other specialists for reconstruction. It is important to point out that although you may see only a small lesion on your skin, it is likely that additional tissue will need to be removed in order to close the wound properly, leaving a scar that may be bigger than you initially anticipated.
Will I have pain after Surgery? Most patients do not complain of pain. If there is any discomfort, Tylenol (acetaminophen) is all that is usually necessary for relief. Stronger pain medication may be required in rare circumstances. Avoid taking aspirin-containing medications or Motrin (Advil, ibuprofen) as they may cause bleeding.
PREPARING FOR MOHS SURGERY:
Bring your Calendar to your Consultation Appointment: You will be scheduled for your surgery after you met with Dr. Cronquist. The appointment will be made when you check out.
Medications: Continue any medication prescribed by your doctor. Because aspirin can prolong bleeding, we ask that you avoid aspirin and aspirin-containing products (including Anacin, Bufferin, Excedrin, Alka Seltzer, and Percodan) unless specifically prescribed by your physician. Also avoid products containing ibuprofen (Advil, Motrin). Other over-the-counter items such as vitamin E, alcohol, and ginkgo biloba should be avoided. If you are using blood-thinning agents (like Coumadin, or Plavix) please inform the Mohs surgeon. We do not require that you stop a prescribed agent, such as Coumadin, but wish to be informed as they may increase bleeding risk in large cases.
Tips: Get a good night’s sleep the night before your scheduled surgery. Eat your normal breakfast on the day of surgery, and plan on bringing a snack, if needed, during the day. Plan to bring reading materials. Personal music devices (such as iPods) are welcome, though we may request you discontinue use during the actual procedure. Wear comfortable clothes, preferably loose fitting to allow for easy removal over the wound dressing once home. If you use contact lenses, please do not wear them on the day of surgery, unless specifically cleared by the Mohs surgeon. If your surgery is planned for areas around the lips, mouth, or jaw, plan to have soft, easy-to-chew foods available to minimize stretch and strain during wound healing.
Wound Care Supplies: Fresh container of plain white petroleum jelly (Vaseline) or Aquaphor ointment, for daily wound care. Baby shampoo is useful for gently cleaning wounds after the bandage is removed (usually 1-2 days after the procedure). Extra Strength Tylenol (acetaminophen) for minor post-op pain, if recommended by the Mohs Surgeon. Have a cold pack available, such as a bag of frozen peas or corn, if recommended to minimize post-operative pain and swelling on the day of surgery.
AFTER MOHS SURGERY
Will I need to come back?The Mohs surgeon usually sees our patients back in one tofour weeks to inspect the wound and to remove stitches if necessary. We will schedule a follow up visit once your surgery is complete. Some wounds are also rechecked at 2 – 3 months for proper healing and cosmetic appraisal.
Will I get more Skin Cancers? Statistically, patients who have one skin cancer are at a 40% risk to acquire a new skin cancer (different site than the first) within 5 years. We recommend that you plan on annual skin evaluations with your general dermatologist.
What can I do to protect myself from developing more skin cancer? Protect yourself from further sun damage. Even if you tan easily, the sun can contribute to skin cancer in two ways: (1) sunlight damages the genes that control cell growth and regulation, and (2) sunlight damages the body’s immune system so that early cancers tend to grow unchecked by normal immune defense. Performing self-examination of your skin each month may alert you to early, smaller skin cancers that may be treated more easily. Minimize your exposure by (1) Use SPF 30 (or greater) UVA & UVB protecting sun block daily: (2) Avoid mid-day sun between the hours of 10 a.m. and 4 p.m.; (3) Wear a hat and sun protective clothing.